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[肿瘤治疗的内分泌副作用]

[Endocrine side effects of tumor treatment].

作者信息

Braegelmann Johanna, Führer Dagmar, Tan Susanne

机构信息

Klinik für Endokrinologie, Diabetologie und Stoffwechsel, Universitätsklinikum Essen, Universitätsmedizin Essen, Hufelandstraße 55, 45147, Essen, Deutschland.

出版信息

Inn Med (Heidelb). 2024 Jul;65(7):681-689. doi: 10.1007/s00108-024-01731-1. Epub 2024 Jun 14.

Abstract

Targeted and immune-based treatments represent significant innovations in oncology and impressively improve the prognosis of many tumor diseases. Their now widespread use as a standard treatment for several malignant diseases increasingly requires knowledge of how to deal with new adverse events (AE) induced by oncological agents in centers and routine practice [12, 13]. For example, the blockade of specific checkpoints of the inhibitory immune system by immune checkpoint inhibitors (ICI) causes the loss of immune tolerance to the body's own tissue with the occurrence of endocrine immune-related AE (irAE) in approximately 10% of patients treated with ICI [3, 11]. Targeted treatments, such as with tyrosine kinase inhibitors (TKI), mammalian target of rapamycin (mTOR) and phosphoinositide 3‑kinase (PI3K) inhibitors often lead to disorders of glucose metabolism and thyroid gland dysfunction. The challenges of maintaining bone health during endocrine therapy in patients with prostate and hormone receptor-positive breast cancer and in the endocrine follow-up care of childhood cancer survivors are well-known and are becoming increasingly more important for the long-term prognosis and quality of life [5, 20]. However, although the recommendations for a systematic management of endocrine side effects of these relatively new tumor therapies can be found in guidelines, they are not yet established in routine clinical care [15, 19]. A close interdisciplinary cooperation is required for optimal care of people with cancer [7]. The development of such interdisciplinary cross-sectoral treatment structures is important as tumor treatment is primarily carried out by hematologists or oncologists, while the management of AE induced by oncological agents increasingly involves primary care physicians including internists and in the case of endocrine AE requires the specific expertise of endocrinologists and diabetologists.

摘要

靶向治疗和免疫治疗是肿瘤学领域的重大创新,显著改善了许多肿瘤疾病的预后。它们作为几种恶性疾病的标准治疗方法如今已广泛应用,这越来越需要了解在医疗中心和日常实践中如何应对肿瘤药物引发的新的不良事件(AE)[12, 13]。例如,免疫检查点抑制剂(ICI)阻断抑制性免疫系统的特定检查点,会导致机体对自身组织失去免疫耐受性,约10%接受ICI治疗的患者会出现内分泌免疫相关不良事件(irAE)[3, 11]。靶向治疗,如使用酪氨酸激酶抑制剂(TKI)、雷帕霉素靶蛋白(mTOR)和磷酸肌醇3激酶(PI3K)抑制剂,常常会导致糖代谢紊乱和甲状腺功能障碍。在前列腺癌和激素受体阳性乳腺癌患者的内分泌治疗期间以及儿童癌症幸存者的内分泌随访护理中,维持骨骼健康面临的挑战是众所周知的,并且对于长期预后和生活质量变得越来越重要[5, 20]。然而,尽管在指南中可以找到关于这些相对较新的肿瘤治疗内分泌副作用系统管理的建议,但它们在常规临床护理中尚未确立[15, 19]。为了对癌症患者进行最佳护理,需要密切的跨学科合作[7]。由于肿瘤治疗主要由血液科医生或肿瘤内科医生进行,而肿瘤药物引发的AE管理越来越多地涉及包括内科医生在内的初级保健医生,并且在内分泌AE的情况下需要内分泌科医生和糖尿病专家的专业知识,因此发展这种跨学科跨部门的治疗结构很重要。

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