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免疫检查点抑制剂相关胃肠道和肝脏毒性的临床处理。

Clinical Management of Gastrointestinal and Liver Toxicities of Immune Checkpoint Inhibitors.

机构信息

Department of Clinical Oncology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China.

Division of Gastroenterology and Hepatology, Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong SAR, China; Institute of Digestive Disease, Chinese University of Hong Kong, Hong Kong SAR, China.

出版信息

Clin Colorectal Cancer. 2024 Mar;23(1):4-13. doi: 10.1016/j.clcc.2023.12.003. Epub 2023 Dec 16.

Abstract

Immune checkpoint inhibitors have transformed the treatment paradigm for various types of cancer. Nonetheless, with the utilization of these groundbreaking treatments, immune-related adverse events (irAEs) are increasingly encountered. Colonic and hepatic involvement are among the most frequently encountered irAEs. Drug-induced side effects, infectious causes, and tumor-related symptoms are the key differentials for irAE complications. Potential risk factors for the development of irAEs include combination use of immune checkpoint inhibitors, past development of irAEs with other immunotherapy treatments, certain concomitant drugs, and a pre-existing personal or family history of autoimmune illness such as inflammatory bowel disease. The importance of early recognition, timely and proper management cannot be understated, as there are profound clinical implications on the overall cancer treatment plan and prognosis once these adverse events occur. Herein, we cover the clinical management of the well-established gastrointestinal irAEs of enterocolitis and hepatitis, and also provide an overview of several other emerging entities.

摘要

免疫检查点抑制剂已经改变了各种类型癌症的治疗模式。尽管如此,随着这些开创性治疗方法的应用,免疫相关不良事件(irAE)的发生率也在不断增加。结肠和肝脏受累是最常见的 irAE 之一。irAE 并发症的主要鉴别诊断包括药物引起的副作用、感染原因和肿瘤相关症状。irAE 发展的潜在危险因素包括免疫检查点抑制剂的联合使用、其他免疫治疗药物治疗中出现 irAE、某些伴随药物以及个人或家族自身免疫性疾病(如炎症性肠病)的既往病史。早期识别、及时和适当的管理非常重要,因为一旦发生这些不良反应,对整体癌症治疗计划和预后都会产生深远的临床影响。在此,我们介绍了已确立的肠炎和肝炎等胃肠道 irAE 的临床管理方法,并概述了其他一些新兴实体。

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