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免疫检查点抑制剂相关的肺炎:从指导方针到前线
1Department of Chemotherapy, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan.
免疫检查点抑制剂 (ICI) 可以导致严重的肺炎 (ICI-P),特别是在患有肺部疾病的患者中. 早期识别和治疗对于管理这种关键副作用至关重要.
科学领域:
- 在瘤学瘤学.
- 肺部病理学 肺部病理学
- 免疫学 免疫学 免疫学
背景情况:
- 免疫检查点抑制剂 (ICI) 彻底改变了癌症治疗,提供了持久的反应.
- 免疫媒介毒性或免疫相关不良事件 (irAEs) 是ICI的已知并发症.
- 与ICI相关的肺炎 (ICI-P) 是一个严重的问题,因为它的严重程度和潜在的治疗中断.
研究的目的:
- 为提供ICI相关肺炎 (ICI-P) 的全面审查.
- 涵盖ICI-P的流行病学,病理生理学,临床表现,诊断,危险因素和治疗策略.
- 突出ICI-P在癌症免疫疗法不断扩大的领域中识别和管理ICI-P的重要性.
主要方法:
- 文献综述和对ICI-P现有数据的综合.
- 流行病学趋势的分析,特别是与临床试验对比的真实世界数据.
- 检查诊断标准,包括成像和生物标志物评估.
- 审查当前和新兴的治疗方式,重点是皮质类固醇和复发管理.
主要成果:
- 在现实环境中,ICI-P比在临床试验中更频繁地发生,先前存在的肺部疾病是关键风险因素.
- 病原发生涉及Th1/Th17炎症和自身抗体,尽管机制需要进一步阐明.
- 在CT扫描上组织类似肺炎的模式是典型的;像KL-6和SP-D这样的生物标志物有助于诊断.
- 高剂量的皮质类固醇是标准治疗,但最优的治疗方案和复发管理 (常见,特别是有组织性肺炎) 正在研究中.
- 在ICI-P后恢复ICI具有很高的复发风险;在停止治疗后,免疫调节可能会持续下去.
结论:
- ICI-P是免疫检查点抑制剂的关键毒性,需要警监测和及时管理.
- 考虑风险因素和疾病模式的个性化治疗策略对于最佳的患者结果至关重要.
- 结合生物标志物,现实世界的证据和人工智能的未来研究有望改善ICI-P管理和患者护理.
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