Pozzessere Chiara, Mazini Bianca, Omoumi Patrick, Jreige Mario, Noirez Leslie, Digklia Antonia, Fasquelle François, Sempoux Christine, Dromain Clarisse
Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV), CH-1011 Lausanne, Switzerland.
Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital (CHUV), CH-1011 Lausanne, Switzerland.
Cancers (Basel). 2024 Jul 19;16(14):2585. doi: 10.3390/cancers16142585.
Immunotherapy has revolutionized oncology care, improving patient outcomes in several cancers. However, these therapies are also associated with typical immune-related adverse events due to the enhanced inflammatory and immune response. These toxicities can arise at any time during treatment but are more frequent within the first few months. Any organ and tissue can be affected, ranging from mild to life-threatening. While some manifestations are common and more often mild, such as dermatitis and colitis, others are rarer and more severe, such as myocarditis. Management depends on the severity, with treatment being held for >grade 2 toxicities. Steroids are used in more severe cases, and immunosuppressive treatment may be considered for non-responsive toxicities, along with specific organ support. A multidisciplinary approach is mandatory for prompt identification and management. The diagnosis is primarily of exclusion. It often relies on imaging features, and, when possible, cytologic and/or pathological analyses are performed for confirmation. In case of clinical suspicion, imaging is required to assess the presence, extent, and features of abnormalities and to evoke and rule out differential diagnoses. This imaging-based review illustrates the diverse system-specific toxicities associated with immune checkpoint inhibitors and chimeric antigen receptor T-cells with a multidisciplinary perspective. Clinical characteristics, imaging features, cytological and histological patterns, as well as the management approach, are presented with insights into radiological tips to distinguish these toxicities from the most important differential diagnoses and mimickers-including tumor progression, pseudoprogression, inflammation, and infection-to guide imaging and clinical specialists in the pathway of diagnosing immune-related adverse events.
免疫疗法彻底改变了肿瘤治疗方式，改善了多种癌症患者的治疗效果。然而，由于炎症和免疫反应增强，这些疗法也会引发典型的免疫相关不良事件。这些毒性反应可在治疗期间的任何时候出现，但在最初几个月更为常见。任何器官和组织都可能受到影响，程度从轻度到危及生命不等。虽然有些表现较为常见且多为轻度，如皮炎和结肠炎，但其他表现则较为罕见且更为严重，如心肌炎。治疗取决于毒性的严重程度，2级以上毒性反应需暂停治疗。更严重的病例会使用类固醇，对于无反应的毒性反应可考虑使用免疫抑制治疗，同时给予特定器官支持。多学科方法对于及时识别和管理至关重要。诊断主要是排除性的。通常依赖影像学特征，如有可能，进行细胞学和/或病理学分析以确诊。临床怀疑时，需要进行影像学检查以评估异常的存在、范围和特征，并引发和排除鉴别诊断。本基于影像学的综述从多学科角度阐述了与免疫检查点抑制剂和嵌合抗原受体T细胞相关的各种系统特异性毒性。文中介绍了临床特征、影像学特征、细胞学和组织学模式以及管理方法，并深入探讨了放射学提示，以将这些毒性与最重要的鉴别诊断和模仿物（包括肿瘤进展、假性进展、炎症和感染）区分开来，从而指导影像学和临床专家在诊断免疫相关不良事件的过程中做出判断。
