检查点抑制剂诱导的低性炎的差异:单疗法和组合疗法诱导的低性炎
Stephanie van der Leij1,2, Karijn P M Suijkerbuijk3, Medard F M van den Broek1,3
1Department of Endocrinology, University Medical Center, Utrecht University, Utrecht, Netherlands.
Frontiers in endocrinology
|August 13, 2024
概括
免疫检查点抑制剂 (ICI) 治疗可能会导致缺血炎,这是一个副作用. 这项研究发现,ICI的类型会影响下体炎的呈现和脑垂体MRI发现,激素缺乏症的恢复率有所不同.
科学领域:
- 在瘤学瘤学.
- 内分泌学 在内分泌学.
- 免疫学 免疫学 免疫学
背景情况:
- 免疫检查点抑制剂 (ICI) 提供了革命性的癌症治疗方法,但可以导致免疫相关的不良事件 (irAEs),包括低血压炎.
- 垂体腺炎,即垂体腺炎,是各种ICI的已知irAE,包括抗PD-(L) 1,抗CTLA-4和组合疗法.
- 了解ICI诱导的低体炎的不同临床表现和管理需求对于患者护理至关重要.
研究的目的:
- 分析和比较由不同类型的ICI诱导的低血清炎的临床表现,诊断结果和内分泌恢复模式.
- 为了识别由抗PD-(L) 1 ,抗CTLA-4和联合抗CTLA-4/PD-1疗法引起的阴囊炎的特定差异.
主要方法:
- 对67名在ICI治疗后被诊断患有下体炎的患者进行了回顾性分析.
- 患者数据包括ICI类型 (抗PD-(L) 1,抗CTLA-4或抗CTLA-4/PD-1),临床症状,垂体MRI发现和内分泌功能测试.
- 在ICI治疗组中,比较了诸如发病时间,特定激素缺乏,MRI异常和内分泌恢复等结果.
主要成果:
- 与抗CTLA-4 (11周) 和抗CTLA-4/PD-1 (14周) 相比,抗PD-(L) 1疗法 (22周) 的中位时间到缺血炎的发病时间更长.
- 抗CTLA-4或抗CTLA-4/PD-1疗法诱导的低体质炎中,头痛和TSH,LH/FSH和ACTH的缺陷更为频繁.
- pituitary MRI 异常,包括hypophysitis 和二次空综合征,仅在接受抗CTLA-4 或抗CTLA-4/PD-1 治疗的患者中观察到.
结论:
- 与免疫相关的低血压炎 (IR-hypophysitis) 的临床表现和诊断结果根据所使用的特定类型的免疫检查点抑制剂有显著差异.
- 当与抗CTLA-4或抗CTLA-4/PD-1疗法相关时,MRI异常更容易表明缺血炎.
- 虽然从TSH和LH/FSH缺陷中恢复是常见的,但ACTH缺陷的恢复是罕见的,并且不受皮质类固醇剂量的影响.
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