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免疫检查点抑制剂与内分泌疾病:韩国内分泌学会立场声明

Immune Checkpoint Inhibitors and Endocrine Disorders: A Position Statement from the Korean Endocrine Society.

机构信息

Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.

出版信息

Endocrinol Metab (Seoul). 2022 Dec;37(6):839-850. doi: 10.3803/EnM.2022.1627. Epub 2022 Dec 26.

Abstract

Immune checkpoint inhibitors (ICIs) including an anti-cytotoxic T-lymphocyte-associated antigen 4 inhibitor, anti-programmed cell death protein 1 (PD-1) inhibitors, and anti-PD-ligand 1 inhibitors are representative therapeutics for various malignancies. In oncology, the application of ICIs is currently expanding to a wider range of malignancies due to their remarkable clinical outcomes. ICIs target immune checkpoints which suppress the activity of T-cells that are specific for tumor antigens, thereby allowing tumor cells to escape the immune response. However, immune checkpoints also play a crucial role in preventing autoimmune reactions. Therefore, ICIs targeting immune checkpoints can trigger various immune-related adverse events (irAEs), especially in endocrine organs. Considering the endocrine organs that are frequently involved, irAEs associated endocrinopathies are frequently life-threatening and have unfavorable clinical implications for patients. However, there are very limited data from large clinical trials that would inform the development of clinical guidelines for patients with irAEs associated endocrinopathies. Considering the current clinical situation, in which the scope and scale of the application of ICIs are increasing, position statements from clinical specialists play an essential role in providing the appropriate recommendations based on both medical evidence and clinical experience. As endocrinologists, we would like to present precautions and recommendations for the management of immune-related endocrine disorders, especially those involving the adrenal, thyroid, and pituitary glands caused by ICIs.

摘要

免疫检查点抑制剂(ICIs)包括抗细胞毒性 T 淋巴细胞相关抗原 4 抑制剂、抗程序性细胞死亡蛋白 1(PD-1)抑制剂和抗 PD-配体 1 抑制剂,是各种恶性肿瘤的代表性治疗方法。在肿瘤学领域,由于其显著的临床疗效,ICI 的应用目前正在扩展到更广泛的恶性肿瘤范围。ICI 靶向免疫检查点,抑制针对肿瘤抗原的 T 细胞的活性,从而使肿瘤细胞逃避免疫反应。然而,免疫检查点在防止自身免疫反应方面也起着至关重要的作用。因此,针对免疫检查点的 ICI 可以引发各种免疫相关的不良反应(irAEs),特别是在内分泌器官中。考虑到经常涉及的内分泌器官,与 irAEs 相关的内分泌疾病经常危及生命,并对患者的临床预后产生不利影响。然而,来自大型临床试验的关于 irAEs 相关内分泌疾病的发展的临床指南的数据非常有限。考虑到目前的临床情况,即 ICI 的应用范围和规模正在扩大,临床专家的立场声明在根据医学证据和临床经验提供适当建议方面发挥着重要作用。作为内分泌学家,我们希望提出免疫相关内分泌疾病管理的预防措施和建议,特别是涉及由 ICI 引起的肾上腺、甲状腺和垂体的疾病。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0f1e/9816514/36618b311dd5/enm-2022-1627f1.jpg

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