免疫检查点抑制剂相关的神经毒性:发生率和管理. 一个系统的审查和元分析
Dorte Lisbet Nielsen1, Carsten Bogh Juhl2, Inna Markovna Chen1
1Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Cancer treatment reviews
|August 12, 2025
概括
免疫检查点抑制剂 (ICI) 可以导致罕见但严重的神经系统不良事件 (NAE). 虽然大多数患者的病情有所改善,但有些人经历了持久的影响或死亡,特别是"三重M"综合征,需要仔细监测.
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) 是一种重要的癌症治疗方法.
- 免疫相关的不良事件 (irAEs),包括神经学并发症 (NAEs),是潜在的严重副作用.
- 了解NAE对于患者安全和治疗优化至关重要.
研究的目的:
- 确定与ICI相关的NAE的发生率和频谱.
- 评估管理策略,以减轻国家级企业的影响.
- 分析经历NAE的患者的结局和死亡率.
主要方法:
- 对657项临床试验 (91,340名参与者) 进行了元分析,以评估NAE发生率.
- 一个系统的文献审查检查了irNAEs的临床表现和治疗方法.
- 随机效应模型被用于发病率总结.
主要成果:
- 所有级别的NAE的整体发病率为0.24%.
- 治疗后脑部事件增加,占死亡事件的54%.
- 77%的irNAE患者有所改善,但42%的患者有后果;整体死亡率为17.1%.
结论:
- 与ICI相关的NAE虽然不常见,但可以导致显著的发病率和死亡率.
- "三重M"综合征 (肌痛性质,肌肉炎,心肌炎) 的死亡率很高 (38%).
- 密集的呼吸监测和支持对于改善"三M"患者的治疗结果至关重要.
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