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[免疫疗法和靶向肿瘤治疗下的药物相关皮疹]

[Drug-related exanthema under immunotherapy and targeted oncological therapy].

作者信息

Ziemer Mirjana, Livingstone Elisabeth

机构信息

Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Leipzig, Philipp-Rosenthal-Str. 23, 04103, Leipzig, Deutschland.

Klinik für Dermatologie, Allergologie und Venerologie, Universitätsmedizin Essen, Hufelandstr. 55, 45122, Essen, Deutschland.

出版信息

Dermatologie (Heidelb). 2024 Jun;75(6):440-450. doi: 10.1007/s00105-024-05350-7. Epub 2024 May 21.

DOI:10.1007/s00105-024-05350-7
PMID:38772932
Abstract

BACKGROUND

Oncological therapies can cause a variety of mucocutaneous adverse events. Exanthematous adverse events can be challenging in the context of the urgent need for cancer treatment due to their spread, sometimes rapid progression, and mucous membrane or organ involvement.

MATERIALS AND METHODS

This article provides an overview of the most important exanthematic dermatoses as side effects of modern drug-based tumor therapies with diagnostic and therapeutic information for clinicians, taking into account the current literature and guidelines.

RESULTS

Exanthematous adverse events of immune checkpoint inhibitors, EGFR antagonists, kinase inhibitors, bispecific T‑cell engagers, and the CCR4 inhibitor mogamulizumab are reviewed in detail.

CONCLUSIONS

Cutaneous side effects are common across all drug classes and cover a broad spectrum. While some adverse events are specific to one drug class, many exanthemas can occur with both oncological immunotherapies and various targeted therapies. A reliable diagnosis, dose adjustment or discontinuation of the offending agent in consultation with the treating oncologists and appropriate symptomatic therapy are important for correct management. In the case of severe, life-threatening drug reactions, however, permanent discontinuation of the drug is essential.

摘要

背景

肿瘤治疗可引发多种皮肤黏膜不良事件。由于皮疹性不良事件会扩散,有时进展迅速,且累及黏膜或器官,在急需进行癌症治疗的情况下,这类事件颇具挑战性。

材料与方法

本文结合当前文献和指南,概述了现代基于药物的肿瘤治疗副作用中最重要的皮疹性皮肤病,并为临床医生提供诊断和治疗信息。

结果

详细综述了免疫检查点抑制剂、表皮生长因子受体拮抗剂、激酶抑制剂、双特异性T细胞衔接器以及CCR4抑制剂莫加莫拉单抗的皮疹性不良事件。

结论

皮肤副作用在所有药物类别中都很常见,且范围广泛。虽然有些不良事件特定于某一药物类别,但许多皮疹可同时出现在肿瘤免疫治疗和各种靶向治疗中。与主治肿瘤学家协商进行可靠诊断、调整剂量或停用致病药物,并进行适当的对症治疗,对于正确管理至关重要。然而,对于严重的、危及生命的药物反应,必须永久停用该药物。