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免疫检查点抑制剂用于患有先前自身免疫神经系统疾病的患者

Kylie Fletcher¹, Marc Machaalani², Razane El Hajj Chehade²

¹Vanderbilt University School of Medicine, Nashville, Tennessee.

JAMA network open

|June 4, 2025

概括

免疫检查点抑制剂 (ICI) 在神经系统自身免疫性疾病中显示出不同的安全性. 肌痛性硬化症患者经历了频繁的恶化,而多发性硬化症患者则较少,没有观察到显著的生存差异.

科学领域:

在瘤学瘤学.
神经学神经学
免疫学免疫学免疫学

背景情况:

免疫检查点抑制剂 (ICI) 是有效的癌症治疗方法,但可能导致与免疫相关的不良事件 (irAEs).
患有先前自身免疫性疾病的患者往往被排除在ICI试验之外,限制了对其安全性和有效性的理解.
在患有先前存在的神经性自身免疫性疾病 (NAIDs) 的患者中,ICI的安全性和有效性仍然缺乏特征.

研究的目的:

评估ICI治疗在患有先前存在的NAID的患者中的安全性和临床结果.
为了比较不同NAID和对照组的ICI耐受性和结果.

主要方法:

一项多中心回顾性队列研究包括135名癌症患者接受ICI治疗 (2013年10月至2023年5月).
患者有先前存在的多发性硬化症 (MS),严重骨髓灰质炎 (MG),吉兰-巴雷综合征 (GBS) 或其他NAIDs.
为了进行比较,包括了患有帕金森病 (PD) 的对照队列.

主要成果:

骨髓灰质炎 (MG) 患者的ICI相关恶化率最高 (67%),往往需要住院治疗或导致死亡.
多发性硬化症 (MS) 患者的恶化率较低 (18%).
在NAID组之间没有观察到响应率,无进展生存率 (PFS) 或总生存率 (OS) 的显著差异.

结论:

对于患有某些先前存在的NAID,包括MS的癌症患者来说,ICI治疗可能是一个可行的选择.
患有MG的患者需要仔细监测,因为严重恶化的风险更高.
需要进一步的研究来优化ICI在这个人群中的使用.

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