免疫检查点抑制剂在患有癌症和既有自身免疫性疾病患者中的疗效与安全性
The Efficacy and Safety of Immune Checkpoint Inhibitors in Patients With Cancer and Preexisting Autoimmune Disease.
作者信息
Tang Hui, Zhou Jianfeng, Bai Chunmei
机构信息
Department of Medical Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Front Oncol. 2021 Feb 22;11:625872. doi: 10.3389/fonc.2021.625872. eCollection 2021.
Abstract
Immune checkpoint inhibitor (ICI) is a revolutionary breakthrough in the field of cancer treatment. Because of dysregulated activation of the immune system, patients with autoimmune disease (AID) are usually excluded from ICI clinical trials. Due to a large number of cancer patients with preexisting AID, the safety and efficacy of ICIs in these patients deserve more attention. This review summarizes and analyzes the data regarding ICI therapy in cancer patients with preexisting AID from 17 published studies. Available data suggests that the efficacy of ICIs in AID patients is comparable to that in the general population, and the incidence of immune-related adverse events (irAEs) is higher but still manageable. It is recommended to administer ICIs with close monitoring of irAEs in patients with a possibly high benefit-risk ratio after a multidisciplinary discussion based on the patient's AID category and severity, the patient's tumor type and prognosis, alternative treatment options, and the patient's intention. Besides, the prevention and management of irAEs in AID patients have been discussed.
摘要
免疫检查点抑制剂（ICI）是癌症治疗领域的一项革命性突破。由于免疫系统激活失调，自身免疫性疾病（AID）患者通常被排除在ICI临床试验之外。鉴于大量癌症患者合并存在AID，ICI在这些患者中的安全性和疗效值得更多关注。本综述总结并分析了17项已发表研究中关于合并存在AID的癌症患者接受ICI治疗的数据。现有数据表明，ICI在AID患者中的疗效与普通人群相当，免疫相关不良事件（irAE）的发生率更高，但仍可控制。建议在多学科讨论后，根据患者的AID类别和严重程度、患者的肿瘤类型和预后、替代治疗方案以及患者意愿，对可能具有高获益风险比的患者密切监测irAE的情况下给予ICI治疗。此外，还讨论了AID患者irAE的预防和管理。
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