与皮质类固醇耐药性免疫相关的不良事件:系统性审查
Eveline Daetwyler1, Till Wallrabenstein1,2, David König1
1Division of Medical Oncology, University Hospital Basel, Basel, Switzerland.
Journal for immunotherapy of cancer
|January 17, 2024
概括
免疫检查点抑制剂 (ICI) 可以导致严重的免疫相关不良事件 (irAEs). 这次审查发现治疗耐固醇 (sr) 的irAEs的证据有限,建议针对肝炎和大肠炎分别使用mycophenolate mofetil和infliximab等特定药物.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
- 药理学 药理学是指药理学的学科.
背景情况:
- 免疫检查点抑制剂 (ICI) 是重要的癌症疗法,但可能导致严重的免疫相关不良事件 (irAEs).
- 皮质类固醇是对irAEs的主要治疗方法,但耐固醇 (sr) 病例缺乏明确的管理指南.
- 关于管理包括肝炎,结肠炎,肺炎和心肌炎在内的serious irAEs的证据主要基于有限的病例系列和报告.
研究的目的:
- 系统地审查和总结治疗癌症患者耐固醇免疫相关不良事件 (sr-irAEs) 的现有证据.
- 确定除了皮质类固醇之外的有效治疗选择,用于严重的影响肝脏,结肠,肺和心脏的irAEs.
- 在初始皮质类固醇治疗失败时,提供基于证据的建议来管理sr-irAEs.
主要方法:
- 在PubMed进行了系统的文献搜索,包括主要瘤学会的相关临床指南.
- 包括癌症患者在ICI治疗期间或之后出现肝炎,结肠炎,肺炎或心肌炎的研究和病例报告,对皮质类固醇反应不足.
- 专注于识别耐固醇 (sr) 的irAEs的治疗方法,分析基于受影响器官系统的数据.
主要成果:
- 关于危及生命的sri-irAEs的数据有限,大多数出版物都是单个病例报告.
- 报告的类固醇耐药性大肠炎最常见 (n=26),其次是肝炎 (n=21),肺炎 (n=17) 和心肌炎 (n=15).
- 菌酸莫菲蒂尔 (MMF) 显示出对神经硬性肝炎的承诺;对神经硬性结肠炎的infliximab (其次是vedolizumab);对神经硬性肺炎的MMF和IVIG;以及对神经硬性心肌炎的atacept或ATG.
结论:
- 迅速识别和治疗sr-irAEs至关重要,因为目前的指南建议不准确.
- 推用于sr-irAEs的第一线治疗包括MMF治疗肝炎,infliximab治疗大肠炎,MMF/IVIG治疗肺炎,以及atacept/ATG治疗心肌炎.
- 如果皮质类固醇在3天内无效,应立即开始使用这些替代性免疫抑制剂.
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