承认和应对治疗免疫相关不良事件的现实挑战
Mitchell S von Itzstein1,2, David E Gerber1,2,3, Bonnie L Bermas4
1Division of Hematology and Oncology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Journal for immunotherapy of cancer
|July 22, 2024
概括
免疫检查点抑制剂 (ICI) 提供了革命性的癌症治疗方法,但可以引起与免疫相关的不良事件 (irAEs). 目前对这些自身免疫性毒性的管理不足以达到最佳水平,需要改进患者护理策略.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
- 类风湿病学 类风湿病学
背景情况:
- 免疫检查点抑制剂 (ICI) 已经改变了癌症治疗.
- 由于自身免疫性和不可预测性,ICI诱导的免疫相关不良事件 (irAEs) 带来了重大的临床挑战.
- 由于药物的生物可用性,持久性病理和模糊的治疗指南,管理变得复杂.
研究的目的:
- 讨论管理ICI诱导的IRE所面临的挑战.
- 突出需要改进诊断和治疗策略的需要.
- 为推进iRAE护理提出解决方案.
主要方法:
- 基于当前文献和临床经验的评论.
- 讨论现有的管理准则及其局限性.
- 探索有效的irAE治疗的障碍.
主要成果:
- 目前的irAE管理不足于最佳,对类固醇使用和其他免疫抑制剂的指导方针模糊.
- 诊断的延迟,获得护理以及缺乏FDA批准的治疗方法造成了重大障碍.
- 生物疗法的高成本和保险拒绝进一步使治疗复杂化.
结论:
- 对于对irAE诊断和管理进行优化,基于证据的指导方针至关重要.
- 增加副专家的参与,如风湿病学家,对于导航复杂的自身免疫毒性至关重要.
- 解决财务和后勤障碍对于改善ICI治疗患者的治疗结果至关重要.
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