Coudert Valentin, Penel Nicolas, Le Deley Marie Cécile, Forestier Alexandra
Centre Oscar Lambret, medical oncology department, 3, rue Combemale, 59020 Lille cedex, France.
Centre Oscar Lambret, medical oncology department, 3, rue Combemale, 59020 Lille cedex, France; Lille University, School of Medicine, Lille, France.
Bull Cancer. 2022 Nov;109(11):1217-1226. doi: 10.1016/j.bulcan.2022.07.005. Epub 2022 Sep 7.
Immune checkpoint inhibitors (ICI) are an increasing proportion of oncology therapies. The oncologist is faced with the managing immune-mediated adverse effects (irAEs), which are sometimes complex, the introduction of ICIs in patients with history of autoimmune diseases, and rechallenging after toxicity. This multidisciplinary care is still uneven. The main objective of this study is to describe the management of this irAES within the university hospitals (UH) with oncology department and comprehensive cancer centers (CCC). We built this study around a survey sent to all UH and CCC in metropolitan France, as well as to all the hospitals authorized to treat cancer in the Nord Pas de Calais region, in order to assess the resources available and the areas of improvement. Multidisciplinary tumor boards dedicated to irAEs were available in 39% of CCCs and UHs, the remaining 61% had a network of specialists. The main problem encountered is the difficulty of bringing together the various specialists. The resources available at the regional level were not well known to the practitioners, who declared that the local resources were insufficient. We have identified five areas for improvement: the generalization of therapeutic education, the strengthening of the city-hospital link, the facilitation of access to specialists who know the specificities of irAE, the sharing of information through pharmacovigilance department and the promotion of further studies.
免疫检查点抑制剂（ICI）在肿瘤治疗中所占比例日益增加。肿瘤学家面临着管理免疫介导的不良反应（irAE）的问题，这些不良反应有时很复杂，还面临着在自身免疫性疾病病史患者中引入ICI以及在出现毒性反应后重新用药的问题。这种多学科护理仍然不均衡。本研究的主要目的是描述在设有肿瘤科的大学医院（UH）和综合癌症中心（CCC）中对这种irAE的管理情况。我们围绕一项调查开展了本研究，该调查发送给了法国大都市的所有UH和CCC，以及北加莱海峡地区所有获准治疗癌症的医院，以评估可用资源和需要改进的方面。39%的CCC和UH设有专门处理irAE的多学科肿瘤委员会，其余61%有专家网络。遇到的主要问题是召集不同专家存在困难。从业者对区域层面可用资源了解不足，他们表示当地资源不足。我们确定了五个需要改进的方面：推广治疗教育；加强城市与医院的联系；便利患者接触了解irAE特殊性的专家；通过药物警戒部门共享信息；以及推动进一步研究。
