癌症患者发展免疫检查点抑制剂相关的AKI的实践模式和结果
Phillip Blanchette1,2,3, Jennifer Reid1, Lucie Richard1
1ICES, London Health Sciences Centre, Lawson Research Institute, London, Ontario, Canada.
概括
免疫检查点抑制剂 (ICI) 治疗癌症的急性损伤 (AKI) 风险很小,低于其他全身疗法. 在AKI后重新挑战ICI患者是不常见的,但可能有利于选定的个人.
科学领域:
- 在瘤学瘤学.
- 腎臟病學 (nephrology) 是一種醫學專業.
- 免疫学 免疫学 免疫学
背景情况:
- 免疫检查点抑制剂 (ICI) 在癌症治疗中至关重要,但可能导致与免疫相关的不良事件,包括急性损伤 (AKI).
- 在ICI治疗后,关于AKI发病率,风险因素和管理的现实数据有限.
研究的目的:
- 确定接受ICI治疗的晚期癌症患者中AKI的发病率,风险因素和结果.
- 为了比较ICI和非ICI全身疗法之间的AKI风险.
- 在AKI之后评估ICI重新挑战的安全性和结果.
主要方法:
- 在加拿大安大略省 (2012-2018) 进行的一项基于人口的队列研究,涉及16,425名晚期癌症患者.
- 根据血清肌素增加和严重程度分级定义的AKI;用于风险和生存分析的时间到事件建模.
- 接受ICI和非ICI全身治疗的患者之间的比较.
主要成果:
- 在接受ICI治疗的4,380名患者中,任何AKI的4年累积发病率为29%,严重AKI为7%.
- AKI的危险因素包括男性性别,尿生殖系统恶性病,高血压,糖尿病,慢性瘤和NSAID使用.
- 与非ICI治疗相比,ICI治疗与AKI的风险明显降低 (aHR=0.80).
- 在因AKI而停止ICI的患者中,9%的患者再次受到挑战,44%的患者经历了复发性AKI.
- 重新挑战ICI与改善的整体存活率 (aHR=0.38) 有关.
结论:
- 接受ICI治疗的癌症患者具有适度的AKI风险,低于其他全身疗法.
- 在AKI发生后,再次使用ICI是不常见的,但可以考虑对特定患者进行重新挑战.
- 对最佳的AKI管理和ICI再挑战策略进行进一步的研究是有必要的.
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