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免疫检查点抑制剂介导的结肠炎诊断与治疗新策略

New strategies in the diagnosis and treatment of immune-checkpoint inhibitor-mediated colitis.

作者信息

Velikova Tsvetelina, Krastev Boris, Gulinac Milena, Zashev Miroslav, Graklanov Vasko, Peruhova Milena

机构信息

Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria.

Medical Center Nadezhda, Medical Center Nadezhda, Sofia 1407, Bulgaria.

出版信息

World J Clin Cases. 2024 Feb 26;12(6):1050-1062. doi: 10.12998/wjcc.v12.i6.1050.

Abstract

Immune-checkpoint inhibitor-mediated colitis (IMC) is an increasingly recognized adverse event in cancer immunotherapy, particularly associated with immune checkpoint inhibitors (ICIs) such as anti-cytotoxic T-lymphocyte antigen-4 and anti-programmed cell death protein-1 antibodies. As this revolutionary immunotherapy gains prominence in cancer treatment, understanding, diagnosing, and effectively managing IMC becomes paramount. IMC represents a unique challenge due to its immune-mediated nature and potential for severe complications. However, a precise picture of IMC pathophysiology is currently unavailable. Therefore, we aimed to summarize the existing data while acknowledging the need for further research. This comprehensive review explores the mechanisms underlying ICIs, gastrointestinal adverse effects, and, in particular, IMC's incidence, prevalence, and features. Our review also emphasizes the importance of recognizing IMC's distinct clinical and histopathological features to differentiate it from other forms of colitis. Furthermore, this paper highlights the urgent need for evolving diagnostic methods, therapeutic strategies, and a multidisciplinary approach to effectively manage IMC.

摘要

免疫检查点抑制剂介导的结肠炎(IMC)是癌症免疫治疗中一种日益被认识到的不良事件,尤其与抗细胞毒性T淋巴细胞抗原4和抗程序性细胞死亡蛋白1抗体等免疫检查点抑制剂(ICIs)相关。随着这种革命性的免疫疗法在癌症治疗中日益突出,了解、诊断和有效管理IMC变得至关重要。由于其免疫介导的性质和严重并发症的可能性,IMC是一个独特的挑战。然而,目前尚无关于IMC病理生理学的确切描述。因此,我们旨在总结现有数据,同时承认有进一步研究的必要。这篇综述全面探讨了ICIs的潜在机制、胃肠道不良反应,特别是IMC的发病率、患病率和特征。我们的综述还强调了认识IMC独特的临床和组织病理学特征以将其与其他形式的结肠炎区分开来的重要性。此外,本文强调迫切需要改进诊断方法、治疗策略以及采用多学科方法来有效管理IMC。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fad1/10921308/bd4b10d95c91/WJCC-12-1050-g001.jpg

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