Division of Respiratory Medicine, Center for Respiratory Diseases, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
NIHR Biomedical Research Centre, School of Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom.
Respir Investig. 2024 May;62(3):339-347. doi: 10.1016/j.resinv.2024.02.002. Epub 2024 Feb 27.
Cancer treatment is undergoing a major transformation with the advent of immunotherapy with immune checkpoint inhibitors. These drugs, which have a different mechanism of action from conventional cytotoxic chemotherapy, are transforming treatment paradigms for many patients suffering from advanced cancer. On the other hand, they are often complicated by specific adverse events, known as immune-related adverse events (irAEs). Infections occurring during immunotherapy with immune checkpoint inhibitors have recently received increasing attention and sometimes are seen as part of irAEs. Amongst these, mycobacterial infections have attracted particular attention. Recent reports have shown that infections occurring during immunotherapy can not only be caused by immunosuppression, but in addition new type of infections are observed that are not caused by immunosuppression. Specifically, tuberculosis (TB) has recently been shown to develop as a result of an imbalance in immunoregulation and an excessive immune response. This review highlights reports of infections during immunotherapy with immune checkpoint inhibitors, followed by a focus on the association with TB and nontuberculous mycobacteria. It concludes with a discussion of the possible mechanisms of pathogenesis and the implications for clinical practice.
癌症治疗正在随着免疫检查点抑制剂免疫疗法的出现发生重大转变。这些药物与传统的细胞毒性化疗具有不同的作用机制，正在改变许多晚期癌症患者的治疗模式。另一方面，它们通常会引起特定的不良反应，称为免疫相关不良反应（irAEs）。在免疫检查点抑制剂免疫治疗期间发生的感染最近受到越来越多的关注，有时被视为 irAEs 的一部分。在这些感染中，分枝杆菌感染引起了特别关注。最近的报告表明，免疫治疗期间发生的感染不仅可能是由免疫抑制引起的，而且还会观察到新的非免疫抑制引起的感染类型。具体而言，最近发现结核病（TB）是由于免疫调节失衡和过度免疫反应引起的。本综述重点介绍了免疫检查点抑制剂免疫治疗期间发生的感染报告，然后重点讨论了与 TB 和非结核分枝杆菌的关联。最后讨论了发病机制的可能机制及其对临床实践的影响。
