Maldonado-García José Luis, Fragozo Ana, Pavón Lenin
Departamento de Bioquímica, Facultad de Medicina, Universidad Nacional Autónoma de México, Coyoacán 04510, Ciudad de México, Mexico.
Departamento de Inmunología, Escuela Nacional de Ciencias Biológicas, Mexico City 1134, Ciudad de México, Mexico.
World J Clin Cases. 2024 Dec 16;12(35):6782-6790. doi: 10.12998/wjcc.v12.i35.6782.
In recent years, cancer immunotherapy has introduced novel treatments, such as monoclonal antibodies, which have facilitated targeted therapies against tumor cells. Programmed death-1 (PD-1) is an immune checkpoint expressed in T cells that regulates the immune system's activity to prevent over-activation and tissue damage caused by inflammation. However, PD-1 is also expressed in tumor cells and functions as an immune evasion mechanism, making it a therapeutic target to enhance the immune response and eliminate tumor cells. Consequently, immune checkpoint inhibitors (ICIs) have emerged as an option for certain tumor types. Nevertheless, blocking immune checkpoints can lead to immune-related adverse events (irAEs), such as psoriasis and cytokine release syndrome (CRS), as exemplified in the clinical case presented by Zhou involving a patient with advanced gastric cancer who received sintilimab, a monoclonal antibody targeting PD-1. Subsequently, the patient experienced exacerbation of psoriasis and CRS. The objective of this editorial article is to elucidate potential immunologic mechanisms that may contribute to the development of CRS and psoriasis in patients receiving ICIs. It is crucial to acknowledge that while ICIs offer superior safety and efficacy compared to conventional therapies, they can also manifest irAEs affecting the skin, gastrointestinal tract, or respiratory system. In severe cases, these irAEs can lead to life-threatening complications such as circulatory shock or multiorgan failure. Consequently, it is recommended that patients receiving ICIs undergo regular monitoring to identify and manage these adverse events effectively.
近年来，癌症免疫疗法引入了新的治疗方法，如单克隆抗体，这些方法促进了针对肿瘤细胞的靶向治疗。程序性死亡受体1（PD-1）是一种在T细胞中表达的免疫检查点，它调节免疫系统的活性，以防止炎症引起的过度激活和组织损伤。然而，PD-1也在肿瘤细胞中表达，并作为一种免疫逃逸机制发挥作用，使其成为增强免疫反应和消除肿瘤细胞的治疗靶点。因此，免疫检查点抑制剂（ICIs）已成为某些肿瘤类型的一种治疗选择。尽管如此，阻断免疫检查点可能会导致免疫相关不良事件（irAEs），如银屑病和细胞因子释放综合征（CRS），正如周所展示的临床病例，一名晚期胃癌患者接受了靶向PD-1的单克隆抗体信迪利单抗治疗。随后，该患者出现银屑病和CRS加重。这篇社论文章的目的是阐明可能导致接受ICIs治疗的患者发生CRS和银屑病的潜在免疫机制。必须认识到，虽然与传统疗法相比，ICIs具有更高的安全性和疗效，但它们也可能表现出影响皮肤、胃肠道或呼吸系统的irAEs。在严重的情况下，这些irAEs可能导致危及生命的并发症，如循环性休克或多器官衰竭。因此，建议接受ICIs治疗的患者进行定期监测，以有效识别和管理这些不良事件。
