Rivet V, Quantin X, Faillie J L, Lesage C, Meunier L, Faure S, Hillaire-Buys D, Lesouder C, Fabre S, Assenat E, Rullier P, Guilpain P, Maria A T J
Service de médecine interne : maladies multi-organiques de l'adulte, hôpital Saint-Éloi, CHRU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France; Faculté de médecine, université de Montpellier, Montpellier, France.
Faculté de médecine, université de Montpellier, Montpellier, France; Service d'oncologie médicale-oncologie thoracique, institut du cancer de Montpellier, Val d'Aurelle, Montpellier, France.
Rev Med Interne. 2021 May;42(5):310-319. doi: 10.1016/j.revmed.2021.01.002. Epub 2021 Jan 21.
Immune checkpoint inhibitors (ICIs) can cause numerous and complex immune-related adverse events whose management need a multidisciplinary approach. Herein, we investigated 114 requests, mostly concerning patients suffering from lung cancer, that were submitted to the « ToxImmun » multidisciplinary meeting in Eastern Occitania between December the 17th 2018 and January the 20th 2020. The leading reasons for the request concerned the putative causal link between immunotherapy and immune-toxicity and its management, followed by possible retreatment after temporary withdrawn because of adverse event, and finally the possibility to initiate ICIs in patients with pre-existing autoimmunity. Colitis, hepatitis and myocarditis were the most frequent immune-related adverse events (IRAEs), both all grade and grade 3-4. Sicca syndrome (with or without Sjogren criteria) was also frequent (26% of cases) and seems to be associated with severe toxicity and multi-toxicity. The mean time to first IRAE was 3.8 months, a time shortened with the use of anti-PD-L1 agents or ICI combination. A majority of requests came from initial evaluation by the internist confirming the early and main role of this specialty in the management of immunotoxicity. Expansion of this regional multidisciplinary meeting, coordinated by internists and medical oncologists, could improve management of immune-related adverse events for the patients' benefits.
免疫检查点抑制剂（ICIs）可引发众多复杂的免疫相关不良事件，其管理需要多学科方法。在此，我们调查了2018年12月17日至2020年1月20日期间提交给东奥克西塔尼亚“ToxImmun”多学科会议的114项请求，这些请求大多涉及肺癌患者。请求的主要原因涉及免疫治疗与免疫毒性之间的假定因果关系及其管理，其次是因不良事件暂时停药后可能的重新治疗，最后是已有自身免疫性疾病的患者启动ICIs的可能性。结肠炎、肝炎和心肌炎是最常见的免疫相关不良事件（IRAEs），包括所有级别以及3 - 4级。干燥综合征（有或无干燥综合征标准）也很常见（占病例的26%），且似乎与严重毒性和多毒性相关。首次出现IRAEs的平均时间为3.8个月，使用抗PD - L1药物或ICIs联合治疗可缩短这一时间。大多数请求来自内科医生的初始评估，证实了该专业在免疫毒性管理中的早期和主要作用。由内科医生和医学肿瘤学家协调扩大这一地区性多学科会议，可能会改善免疫相关不良事件的管理，以造福患者。
