Fane Lauren S, Efird Jimmy T, Jindal Charulata, Biswas Tithi
MD University Program, Case Western Reserve University School of Medicine, Cleveland, OH 44016, USA.
VA Cooperative Studies Program Coordinating Center, Boston, MA 02130, USA.
Biomedicines. 2022 Sep 20;10(10):2339. doi: 10.3390/biomedicines10102339.
The most common immune-related adverse events (irAEs) involve the skin, and several serve as predictors of response to immune checkpoint inhibitor (ICI) therapy, especially in melanoma. Patients with pre-existing skin autoimmune diseases (ADs) have been excluded from ICI studies for safety concerns, yet recent research has shown that dermatological ADs can be managed without discontinuing ICI therapy. Patients with ADs respond as well or better to ICIs and can be included as candidates in clinical trials. Frequently taken during ICI therapy, steroids impair immunotherapy efficacy in certain anatomical sites of tumors but not others, including the brain. ICI efficacy can be enhanced by radiotherapy without increasing adverse events, as neoadjuvant radiotherapy is thought to sensitize tumors to ICIs. This perspective highlights clinical autoimmune considerations of ICI therapy in melanoma and discusses important areas for future exploration.
最常见的免疫相关不良事件（irAE）累及皮肤，其中有几种可作为免疫检查点抑制剂（ICI）治疗反应的预测指标，尤其是在黑色素瘤中。出于安全考虑，患有皮肤自身免疫性疾病（AD）的患者被排除在ICI研究之外，但最近的研究表明，皮肤病AD在不中断ICI治疗的情况下也可得到控制。患有AD的患者对ICI的反应同样良好或更佳，可纳入临床试验候选者。在ICI治疗期间经常使用的类固醇会损害某些肿瘤解剖部位（而非其他部位，包括脑）的免疫治疗疗效。放疗可增强ICI疗效且不增加不良事件，因为新辅助放疗被认为可使肿瘤对ICI敏感。本文观点强调了黑色素瘤ICI治疗中的临床自身免疫相关考量，并讨论了未来探索的重要领域。
