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免疫检查点抑制剂相关听力损失:一项系统评价和个体患者数据分析。

Immune checkpoint inhibitor-related hearing loss: a systematic review and analysis of individual patient data.

机构信息

Medical Oncology Clinic, Health Sciences University, Elazig City Hospital, Ulukent, 23280, Elazig, Turkey.

Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey.

出版信息

Support Care Cancer. 2023 Oct 11;31(12):624. doi: 10.1007/s00520-023-08083-w.


DOI:10.1007/s00520-023-08083-w
PMID:37819422
Abstract

PURPOSE: Immune checkpoint inhibitors (ICIs) are related to various immune-related adverse events (irAEs). However, the knowledge is limited with rare irAEs like hearing loss. Therefore, we evaluated the characteristics, presentation, and treatment of ICI-related hearing loss by reviewing the individual patient data from the previous studies. METHODS: We conducted a systematic search of the Web of Science, PubMed, and Embase databases for studies published until 17 November 2022. The selected MeSH search terms were "hearing loss" OR "hearing impairment" OR "ototoxicity" OR "vestibular toxicity" OR "audiovestibular toxicity" AND "immune checkpoint inhibitor" OR "immunotherapy." RESULTS: A total of 38 patients were included. Melanoma was the most frequent diagnosis (73.7%). The median time from ICI initiation to hearing loss development was 3 months. The hearing impairment was secondary to bilateral sensorineural hearing loss (SNHL) in 24 (68.6%) patients, and at least one other irAE accompanied the hearing loss in 24 patients. Hearing loss significantly improved in 45.7% of the patients. The overall response rate and disease control rate were 67.6% and 85.3%, respectively. CONCLUSION: We observed that most cases of ICI-related hearing loss were reversible, observed in patients with melanoma, accompanied by other irAEs, and associated with a high response rate to ICIs. With the expanded use of ICIs in the earlier treatment lines and adjuvant settings, the number of survivors with ICI-related hearing loss is expected to increase. Further research is needed to define the true prevalence of ICI-related hearing loss, optimal diagnosis, and management.

摘要

目的:免疫检查点抑制剂(ICI)与各种免疫相关不良事件(irAE)有关。然而,由于像听力损失这样罕见的 irAE,人们对其了解有限。因此,我们通过回顾先前研究中的个体患者数据,评估了 ICI 相关听力损失的特征、表现和治疗方法。

方法:我们对 Web of Science、PubMed 和 Embase 数据库进行了系统检索,检索时间截至 2022 年 11 月 17 日。选择的 MeSH 搜索词是“听力损失”或“听力障碍”或“耳毒性”或“前庭毒性”或“听觉前庭毒性”和“免疫检查点抑制剂”或“免疫疗法”。

结果:共纳入 38 例患者。最常见的诊断是黑色素瘤(73.7%)。从 ICI 开始到听力损失发生的中位时间为 3 个月。听力障碍继发于 24 例(68.6%)患者双侧感音神经性听力损失(SNHL),24 例患者至少伴有其他 irAE。45.7%的患者听力损失显著改善。总体缓解率和疾病控制率分别为 67.6%和 85.3%。

结论:我们观察到,大多数 ICI 相关听力损失是可逆的,发生在黑色素瘤患者中,伴有其他 irAE,与 ICI 高反应率相关。随着 ICI 在早期治疗线和辅助治疗中的广泛应用,预计会有更多的幸存者出现 ICI 相关听力损失。需要进一步研究来确定 ICI 相关听力损失的真实患病率、最佳诊断和管理方法。

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本文引用的文献

[1]
Increasing cure rates of solid tumors by immune checkpoint inhibitors.

Exp Hematol Oncol. 2023-1-16

[2]
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Eur J Cancer. 2022-9

[3]
Audiovestibular Toxicity Secondary to Immunotherapy: Case Series and Literature Review.

J Immunother Precis Oncol. 2022-2-3

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N Engl J Med. 2021-11-11

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Clin Cancer Res. 2021-11-1

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Vogt-Koyanagi-Harada-like syndrome in the setting of combined anti-PD1/anti-CTLA4 therapy.

Clin Exp Dermatol. 2021-8

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BMJ. 2021-3-29

[10]
Sudden Otovestibular Dysfunction in 3 Metastatic Melanoma Patients Treated With Immune Checkpoint Inhibitors.

J Immunother. 2021-6-1

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