类固醇前期治疗和单克隆抗体疗法:我们应该重新考虑吗?
Emma-Anne Karlsen1,2,3,4, Euan Walpole5,6, Fiona Simpson7,8
1Frazer Institute, The University of Queensland, Brisbane, Australia. emma.karlsen93@gmail.com.
皮质类固醇前期治疗可能通过抑制抗体依赖细胞中介细胞毒性 (ADCC) 来降低单克隆抗体 (mAb) 癌症治疗的有效性. 将类固醇使用限制在第一剂可以改善抗瘤活性.
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:
- 单克隆抗体 (mAb) 治疗是澳大利亚癌症治疗的基石.
- 许多mAbs通过抗体依赖的细胞介导细胞毒性 (ADCC) 起作用.
- 目前的指导方针经常建议对mAbs进行皮质类固醇前期治疗,以控制输液反应和副作用.
研究的目的:
- 评估皮质类固醇前期治疗对ADCC介导的mAb疗法的疗效的影响.
- 质疑常规使用皮质类固醇与ADCC介导的mAbs.
- 建议修订关于在mAb治疗中使用皮质类固醇的临床实践.
主要方法:
- 对mAb作用机制的现有文献的审查,特别是ADCC.
- 对皮质类固醇对ADCC的已记录的抑制作用的分析.
- 对澳大利亚mAb的当前临床方案和指导方针的评估.
主要成果:
- 已知皮质类固醇可以抑制ADCC,这是许多治疗性mAbs的关键机制.
- 常规使用皮质类固醇可以抵消ADCC介导的mAbs.的抗瘤作用.
- 输液相关反应 (IRR) 主要发生在mAbs.的初始使用期间.
结论:
- 目前的标准护理,包括常规的皮质类固醇前期治疗,可能会降低mAb的疗效.
- 临床医生和机构应考虑将皮质类固醇前期治疗仅限于第一剂量,除非临床上有指示.
- 监管机构应更新产品信息,以披露与ADCC介导的mAbs同时使用类固醇的风险,并应探索替代的抗策略.
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