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免疫检查点抑制剂相关胃炎的再概念化。

Reconceptualization of immune checkpoint inhibitor-associated gastritis.

机构信息

Department of Oncology, Affiliated Hospital of Qinghai University, Xining 810000, Qinghai Province, China.

Ying-Fang Deng and Xian-Shu Cui.

出版信息

World J Gastroenterol. 2024 Sep 28;30(36):4031-4035. doi: 10.3748/wjg.v30.i36.4031.

Abstract

In recent years, with the extensive application of immunotherapy in clinical practice, it has achieved encouraging therapeutic effects. While enhancing clinical efficacy, however, it can also cause autoimmune damage, triggering immune-related adverse events (irAEs). Reports of immunotherapy-induced gastritis have been increasing annually, but due to its atypical clinical symptoms, early diag-nosis poses a certain challenge. Furthermore, it can lead to severe complications such as gastric bleeding, elevating the risk of adverse outcomes for solid tumor patients if immunotherapy is interrupted. Therefore, gaining a thorough under-standing of the pathogenesis, clinical manifestations, diagnostic criteria, and treatment of immune-related gastritis is of utmost importance for early identification, diagnosis, and treatment. Additionally, the treatment of immune-related gastritis should be personalized according to the specific condition of each patient. For patients with grade 2-3 irAEs, restarting immune checkpoint inhibitors (ICIs) therapy may be considered when symptoms subside to grade 0-1. When restarting ICIs therapy, it is often recommended to use different types of ICIs. For grade 4 irAEs, permanent discontinuation of the medication is necessary.

摘要

近年来,免疫疗法在临床实践中的广泛应用取得了令人鼓舞的治疗效果。然而,在提高临床疗效的同时,它也可能导致自身免疫损伤,引发免疫相关不良事件(irAEs)。免疫疗法引起的胃炎的报告逐年增加,但由于其非典型的临床症状,早期诊断具有一定的挑战性。此外,如果中断免疫治疗,它还可能导致严重的并发症,如胃出血,从而增加实体瘤患者不良预后的风险。因此,深入了解免疫相关性胃炎的发病机制、临床表现、诊断标准和治疗方法对于早期识别、诊断和治疗至关重要。此外,免疫相关性胃炎的治疗应根据每个患者的具体情况进行个性化。对于 2-3 级 irAEs 的患者,当症状缓解至 0-1 级时,可考虑重新开始使用免疫检查点抑制剂(ICI)治疗。当重新开始 ICI 治疗时,通常建议使用不同类型的 ICI。对于 4 级 irAEs,则需要永久停止用药。

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Immunotherapy-related gastritis: Two case reports and literature review.免疫治疗相关胃炎:两例病例报告及文献综述
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