Brigida Mattia, Perricelli Alessia, Sposato Fausto, Spadafora Maria Giovanna, Pomillo Angelo, Sisto Milito
Emergency Medicine Department, Universita Cattolica del Sacro Cuore, Rome, Italy.
Medical Oncology Department, Azienda Sanitaria Provinciale, Cosenza, Italy.
Rev Recent Clin Trials. 2020;15(4):339-346. doi: 10.2174/1574887115666200622161418.
The widespread use of immunotherapy drugs in the oncological field has led to the spread of new toxicities compared to the more common chemotherapy treatments. This is because immunotherapy with anti-CTLA-4 (Cytotoxic T Lymphocytes-Associated Antigen 4), anti- PD-1 and anti-PD-L1 monoclonal antibodies has become the standard-of-care in a growing number of indications. Any organ or tissue can be involved, but more commonly, side effects are reported regarding skin, colon, endocrine glands, liver, lung and kidney. Other less frequent, but more serious, adverse events are neurological and myocarditis.
We performed an electronic search on PUBMED of the literature concerning immunotherapy- related toxicities and their management in oncological patients from 2007 to 2020, with particular attention to the most recent publications.
To summarize the different types of immunotherapy-related toxicities, together with their incidence and diagnosis, and to simplify their management, especially in the emergency setting.
Usually, for grade I toxicities, it is not recommended to stop immunotherapy; for most of grade II toxicities, immunotherapy should be postponed to when toxicity will have regressed to grade I, considering the possibility of corticosteroid treatment for most toxicities. The majority of grade III and IV require administration of high-dose corticosteroid intravenous therapy and suspension of immunotherapy. Mortality related to immune checkpoint inhibitors' toxicity, occurring at a rate of 0.3-1.3%, is well below fatality rates due to other oncologic interventions and should not discourage the promising results so far reached by immunotherapy.
与更为常见的化疗治疗相比，免疫治疗药物在肿瘤学领域的广泛应用导致了新的毒性反应的扩散。这是因为使用抗CTLA-4（细胞毒性T淋巴细胞相关抗原4）、抗PD-1和抗PD-L1单克隆抗体进行免疫治疗已在越来越多的适应症中成为标准治疗方法。任何器官或组织都可能受累，但更常见的是，皮肤、结肠、内分泌腺、肝脏、肺和肾脏出现副作用的报道。其他不太常见但更严重的不良事件是神经毒性和心肌炎。
我们在PUBMED上对2007年至2020年期间有关肿瘤患者免疫治疗相关毒性及其管理的文献进行了电子检索，特别关注最新的出版物。
总结免疫治疗相关毒性的不同类型、其发生率和诊断方法，并简化其管理，尤其是在紧急情况下。
通常，对于I级毒性，不建议停止免疫治疗；对于大多数II级毒性，考虑到大多数毒性可采用皮质类固醇治疗，应将免疫治疗推迟到毒性降至I级时进行。大多数III级和IV级毒性需要给予大剂量皮质类固醇静脉治疗并暂停免疫治疗。免疫检查点抑制剂毒性导致的死亡率为0.3-1.3%，远低于其他肿瘤干预措施导致的死亡率，不应阻碍免疫治疗目前取得的良好效果。
