Department of Medicine, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA.
Massachusetts General Hospital Cancer Center, Boston, MA, USA.
Lancet Oncol. 2020 Aug;21(8):e398-e404. doi: 10.1016/S1470-2045(20)30107-8.
Immune checkpoint inhibitors (ICIs) have now been approved in numerous and diverse cancer types and combination regimens. Effective recognition and treatment of ICI toxicities, which might occur acutely, affect any organ system, and produce many distinct clinical syndromes, have emerged as essential goals of ICI management. Thus, developing robust diagnostic and management approaches for ICI toxicity across the health-care system is an urgent and unmet clinical need. In this Personal View, we describe barriers to high-quality care that have constrained the most effective management of patients with cancer receiving ICI treatment. We review education initiatives to enhance patient and physician awareness, which is necessary given the broad spectrum of ICI toxicities often experienced by patients, and assess various systems-based approaches that maximise the chances of appropriate management. In addition, we describe research pipelines that broaden evidence-based approaches and the pathobiology of these novel events. Developing effective, systematic approaches for the recognition and treatment of ICI toxicities will continue to grow in importance as these agents proliferate in cancer care.
免疫检查点抑制剂(ICI)现已在众多不同类型的癌症和联合治疗方案中获得批准。有效识别和治疗 ICI 毒性至关重要,因为这些毒性可能是急性的、影响任何器官系统,并产生许多不同的临床综合征。因此,在整个医疗保健系统中开发针对 ICI 毒性的强大诊断和管理方法是一个紧迫且未满足的临床需求。在本个人观点中,我们描述了限制癌症患者接受 ICI 治疗的最有效管理的高质量护理障碍。我们回顾了旨在提高患者和医生意识的教育计划,因为患者经常经历广泛的 ICI 毒性,需要提高意识,并评估了各种基于系统的方法,以最大限度地提高适当管理的机会。此外,我们描述了扩大这些新型事件的循证方法和病理生物学的研究渠道。随着这些药物在癌症治疗中的广泛应用,开发针对 ICI 毒性的有效、系统的方法将继续变得更加重要。