Rafae Abdul, Ali Sundas, Sana Muhammad Khawar, Rana Farhan Khalid, Ibrahim Ahmed, Ahmed Zahoor, Jan Ali, Ehsan Hamid, Fatima Tehreem, Kunadi Arvind
Department of Internal Medicine, McLaren Flint Michigan State University, Flint, MI, USA.
Department of Internal Medicine, Ascension St. Agnes Hospital, Baltimore, MD, USA.
J Community Hosp Intern Med Perspect. 2022 Apr 12;12(2):35-44. doi: 10.55729/2000-9666.1037. eCollection 2022.
In recent years, immune-checkpoint inhibitors (ICIs) particularly atezolizumab is on the rise in treating advanced malignancies. With its increased clinical use, various electrolyte abnormalities have been reported in the literature. In this review, we have addressed the question of significant electrolyte abnormalities associated with atezolizumab.
Following PRISMA guidelines, we performed a thorough literature search in four databases including PubMed, Cochrane Library, Embase, and Clinicaltrials.gov. We included only randomized controlled trials from 2010 till March 2021. After a comprehensive screening of 1587 articles, we selected 14 articles for our review and tabulated the results. Following MeSH terms were used: "electrolyte abnormalities", "immune checkpoint inhibitors", "atezolizumab".
Non-small cell lung cancer (n = 1270) and metastatic urothelial carcinoma (n = 1164) were the most common malignancies among 3160 patients. The most common electrolyte abnormality was hypomagnesemia (4.7%). Hyponatremia, hypophosphatemia, hypercalcemia and hypokalemia were found in 2.3%, 0.63%, 0.25% and 0.06% patients respectively. For patients taking atezolizumab, hypomagnesemia was most frequently found in non-small cell lung carcinoma patients (9.4%), while urothelial metastatic carcinoma patients most commonly had hyponatremia (5.15%). Hypokalemia though insignificant was observed only in patients with metastatic renal cell carcinoma (2.85%).
Since the use of atezolizumab is on the rise for the treatment of various cancers, more studies need to be conducted to better understand its safety and toxicity profile.
近年来，免疫检查点抑制剂（ICIs）尤其是阿替利珠单抗在治疗晚期恶性肿瘤方面的应用日益广泛。随着其临床应用的增加，文献中报道了各种电解质异常情况。在本综述中，我们探讨了与阿替利珠单抗相关的显著电解质异常问题。
按照PRISMA指南，我们在四个数据库（包括PubMed、Cochrane图书馆、Embase和Clinicaltrials.gov）中进行了全面的文献检索。我们仅纳入了2010年至2021年3月的随机对照试验。在对1587篇文章进行全面筛选后，我们选择了14篇文章进行综述并将结果制成表格。使用了以下医学主题词：“电解质异常”、“免疫检查点抑制剂”、“阿替利珠单抗”。
在3160例患者中，非小细胞肺癌（n = 1270）和转移性尿路上皮癌（n = 1164）是最常见的恶性肿瘤。最常见的电解质异常是低镁血症（4.7%）。低钠血症、低磷血症、高钙血症和低钾血症分别在2.3%、0.63%、0.25%和0.06%的患者中发现。对于使用阿替利珠单抗的患者，低镁血症在非小细胞肺癌患者中最常见（9.4%），而尿路上皮转移性癌患者最常见的是低钠血症（5.15%）。低钾血症虽然不显著，但仅在转移性肾细胞癌患者中观察到（2.85%）。
由于阿替利珠单抗在治疗各种癌症方面的应用日益增加，需要进行更多研究以更好地了解其安全性和毒性特征。
