Ikeda Tatsuki, Nihei Satoru, Saito Kazuki, Asaka Junichi, Kudo Kenzo
Department of Pharmacy, Iwate Medical University Hospital, 2-1-1 Idaidouri, Yahaba-Cho, Iwate, 028-3609, Japan.
Department of Clinical Pharmaceutics and Pharmacy Practice, School of Pharmacy, Iwate Medical University, 2-1-1 Idaidouri, Yahaba-Cho, Iwate, 028-3609, Japan.
J Pharm Health Care Sci. 2024 Dec 18;10(1):78. doi: 10.1186/s40780-024-00400-7.
Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, offering hope for various malignancies by enhancing the immune response against tumors. However, ICIs are associated with unique immune-related adverse events (irAEs), which differ significantly from conventional chemotherapy-induced toxicities. These irAEs, which affect more than 70% of patients and often escalate to severe grades, present substantial clinical management challenges and frequently necessitate emergency hospitalization. Therefore, this study aimed to investigate the clinical characteristics of patients requiring emergency hospitalization due to irAEs during ICI therapy to enhance understanding and improve management strategies.
This retrospective study evaluated patients who received ICIs at Iwate Medical University Hospital between August 1, 2016, and December 31, 2022, and required emergency hospitalization due to irAEs. Clinical data were extracted from the medical records, including patient demographics, presenting complaints, time from ICI initiation to hospitalization, irAE diagnoses, and treatment outcomes. The Spearman rank correlation coefficient was used to analyze the associations between the chief complaints and irAE diagnoses.
Of 1009 ICI-treated patients, 96 required emergency hospitalization for irAEs. The cohort's mean age was 73 years, with 75.0% of patients being male. Among patients who required emergency hospitalization, a high proportion were undergoing treatment for lung cancer (41.7%). The median hospitalization duration was 87 days. The chief complaints included dyspnea (34.4%) and fatigue (34.4%), with gastrointestinal and respiratory disorders being the most frequent irAEs (35.4%). Significant correlations were observed between dyspnea and respiratory diseases (Rs = 0.66), skin diseases and disorders (Rs = 0.81), pain and musculoskeletal disorders (Rs = 0.59), and diarrhea and gastrointestinal disorders (Rs = 0.49). Corticosteroids were administered to 64.6% of the patients. Despite emergency interventions, 8.3% of patients succumbed to irAEs, while 33.3% resumed ICI therapy after hospitalization.
Emergency hospitalization due to irAEs is a considerable concern in ICI therapy, occurring in 9.5% of treated patients. The high incidence of severe irAEs within the first 3 months of treatment underscores the need for early and vigilant monitoring. This study highlights the importance of recognizing and promptly managing irAEs to improve patient outcomes. Future strategies should focus on developing comprehensive management frameworks and enhancing patient and caregiver education to recognize symptoms that warrant immediate medical attention.
免疫检查点抑制剂（ICIs）彻底改变了癌症治疗方式，通过增强针对肿瘤的免疫反应为各种恶性肿瘤带来了希望。然而，ICIs与独特的免疫相关不良事件（irAEs）相关，这些不良事件与传统化疗引起的毒性有显著差异。这些irAEs影响超过70%的患者，且常常升级为严重级别，带来了重大的临床管理挑战，并且经常需要紧急住院治疗。因此，本研究旨在调查ICI治疗期间因irAEs需要紧急住院的患者的临床特征，以增进了解并改进管理策略。
这项回顾性研究评估了2016年8月1日至2022年12月31日期间在岩手医科大学医院接受ICIs治疗且因irAEs需要紧急住院的患者。从病历中提取临床数据，包括患者人口统计学信息、主诉、从开始使用ICI到住院的时间、irAE诊断和治疗结果。采用Spearman等级相关系数分析主诉与irAE诊断之间的关联。
在1009例接受ICI治疗的患者中，96例因irAEs需要紧急住院。该队列的平均年龄为73岁，75.0%的患者为男性。在需要紧急住院的患者中，很大一部分正在接受肺癌治疗（41.7%）。中位住院时间为87天。主诉包括呼吸困难（34.4%）和疲劳（34.4%），胃肠道和呼吸系统疾病是最常见的irAEs（35.4%）。观察到呼吸困难与呼吸系统疾病（Rs = 0.66）、皮肤疾病（Rs = 0.81）、疼痛与肌肉骨骼疾病（Rs = 0.59）以及腹泻与胃肠道疾病（Rs = 0.49）之间存在显著相关性。64.6%的患者接受了皮质类固醇治疗。尽管进行了紧急干预，8.3%的患者死于irAEs，而33.3%的患者在住院后恢复了ICI治疗。
在ICI治疗中，因irAEs导致的紧急住院是一个相当令人担忧的问题，在9.5%的接受治疗患者中发生。治疗前3个月内严重irAEs的高发生率凸显了早期和警惕监测的必要性。本研究强调了识别和及时处理irAEs以改善患者预后的重要性。未来的策略应侧重于制定全面的管理框架，并加强患者和护理人员教育，以识别需要立即就医的症状。
