免疫肿瘤学:胃肠道和肝脏毒性的叙述性综述

Immuno-oncology: a narrative review of gastrointestinal and hepatic toxicities.

作者信息

Boussios Stergios, Sheriff Matin, Rassy Elie, Moschetta Michele, Samartzis Eleftherios P, Hallit Rachel, Sadauskaite Agne, Katsanos Konstantinos H, Christodoulou Dimitrios K, Pavlidis Nicholas

机构信息

King's College London, Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, SE1 9RT, London, UK.

Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, ME7 5NY, Gillingham, Kent, UK.

出版信息

Ann Transl Med. 2021 Mar;9(5):423. doi: 10.21037/atm-20-7361.

Abstract

Vaccines, cytokines, and adoptive cellular therapies (ACT) represent immuno-therapeutic modalities with great development potential, and they are currently approved for the treatment of a limited number of advanced malignancies. The most up-to-date knowledge on the regulation of the anti-cancer immune response has recently led to the development and approval of inhibitors of immune checkpoints, which have produced unprecedented clinical activity in several hard to treat solid malignancies. However, severe adverse events (AEs) represent a limitation to the use of these drugs. Currently approved checkpoint inhibitors block cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed cell death protein (PD-1) and its ligand (PD-L1), resulted in increased survival of patients with several solid and hematologic malignancies. The most common treatment AEs associated with these drugs are fatigue, rash, and auto-immune/inflammatory reactions. Many of the immune-related AEs are reversible and the strategies for their management include supportive care either with or without treatment withdrawal; nevertheless, in severe cases, hospitalization and treatment with immune suppressants, and/or immunomodulators may be required. Steroid therapy is a critical component of the treatment algorithm; nevertheless, the associated immunosuppression may compromise the antitumor response. This article provides a comprehensive and narrative review of luminal gastrointestinal and hepatic complications, including recommendations for their investigation and management.

摘要

疫苗、细胞因子和过继性细胞疗法(ACT)是具有巨大发展潜力的免疫治疗方式,目前已被批准用于治疗少数晚期恶性肿瘤。关于抗癌免疫反应调节的最新知识最近促使了免疫检查点抑制剂的研发和批准,这些抑制剂在几种难以治疗的实体恶性肿瘤中产生了前所未有的临床活性。然而,严重不良事件(AE)是使用这些药物的一个限制因素。目前批准的检查点抑制剂可阻断细胞毒性T淋巴细胞相关抗原4(CTLA-4)、程序性细胞死亡蛋白(PD-1)及其配体(PD-L1),从而提高了几种实体和血液系统恶性肿瘤患者的生存率。与这些药物相关的最常见治疗AE包括疲劳、皮疹和自身免疫/炎症反应。许多免疫相关AE是可逆的,其管理策略包括在停药或不停药的情况下给予支持性治疗;然而,在严重情况下,可能需要住院治疗并使用免疫抑制剂和/或免疫调节剂。类固醇疗法是治疗方案的关键组成部分;然而,相关的免疫抑制可能会损害抗肿瘤反应。本文对管腔胃肠道和肝脏并发症进行了全面的叙述性综述,包括对其检查和管理的建议。

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