免疫检查点抑制剂的严重免疫相关的上胃肠道毒性:一个多中心病例系列
Clément Bresteau1,2, Pauline Bonnet3, Caroline Robert2,4
1Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin Bicêtre, France.
免疫检查点抑制剂 (ICI) 可以导致严重的上部胃肠道免疫相关不良事件 (IRAE). 大多数患者对皮质类固醇或因弗利克西马布反应良好,这表明及时治疗至关重要.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
- 胃肠病学 胃肠病学
背景情况:
- 免疫检查点抑制剂 (ICI) 改善癌症预后,但可能导致与免疫相关的不良事件 (IRAE).
- 关于上部胃肠道 (UGI) IRAE的数据有限.
- 这项研究描述了UGI IRAE,其预后和治疗疗效.
研究的目的:
- 描述免疫检查点抑制剂 (ICI) 治疗后上部胃肠道免疫相关不良事件 (UGI IrAEs) 的临床特征.
- 评估UGI IrAEs的预后和医疗治疗的有效性.
- 为这些不良事件提供临床管理策略的信息.
主要方法:
- 追溯的,多中心的队列研究.
- 纳入标准:患有UGI症状和ICI后中度至重度内镜UGI病变的患者.
- 诱导医学治疗和随访疗效的评估.
主要成果:
- 分析了40名患者,其中85%接受了抗PD(L) 1治疗;45%患有并发性肠球炎.
- 所有患者都呈现出严重的内镜UGI病变.
- 皮质类固醇在80%的患者中实现了反应,在57%的患者中实现了缓解;因弗力西马布显示了75%的反应率.
- 90%的患者在11个月后实现了无皮质类固醇缓解,尽管内镜病变在68%的患者中持续存在.
结论:
- 免疫检查点抑制剂 (ICI) 可以导致严重的上部胃肠道免疫相关不良事件 (UGI IrAEs),通常与并发性肠球炎.
- 皮质类固醇和infliximab是UGI IrAEs的有效治疗方法.
- 建议立即治疗UGI IrAEs,类似于肠球炎的管理.
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