Service d'oncologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
Equal contribution.
Praxis (Bern 1994). 2023;112(3):160-171. doi: 10.1024/1661-8157/a003976.
Immunotherapy with immune checkpoint inhibitors (ICI) is administered in different cancer types and can lead to a wide range of immune-related adverse events including toxicity in vital organs such as the lungs, the kidneys, and the heart. The main hypothesis suggests an overactivation of the immune cells in the different organs. Whereas immune-related cardiotoxicity is very rare but life threatening, ICI-induced acute kidney injury and pneumonitis are more frequent but in general less severe. Renal toxicity corresponds in more than 90% to an acute tubulo-interstitial nephritis. Checkpoint inhibitors pneumonitis is diagnosed mainly on respiratory symptoms with new radiological features, especially under the form of a cryptogenic organising pneumonia. Cardiotoxicity is predominantly marked by myocarditis but also pericarditis and arrhythmias, among others. Early recognition, temporary or definitive cessation of ICI therapy and rapid initiation of high-dose corticosteroids are the cornerstones of the management, which must to be multidisciplinary in a specialised center.
免疫检查点抑制剂（ICI）的免疫疗法应用于不同类型的癌症，可导致广泛的免疫相关不良事件，包括肺部、肾脏和心脏等重要器官的毒性。主要假说认为是不同器官中的免疫细胞过度激活。虽然免疫相关性心肌炎非常罕见但危及生命，但 ICI 诱导的急性肾损伤和肺炎更为常见，但总体上不太严重。肾脏毒性超过 90%的情况对应于急性肾小管间质性肾炎。检查点抑制剂性肺炎主要根据新的放射学特征（尤其是特发性机化性肺炎的形式）和呼吸道症状进行诊断。心肌炎是心脏毒性的主要表现，但也包括心包炎和心律失常等。早期识别、暂时或永久性停止 ICI 治疗以及快速起始大剂量皮质类固醇是管理的基石，必须在专门中心进行多学科治疗。
