重新使用预防性皮质类固醇来缓解肝细胞癌中严重的免疫相关不良事件
Ying-Chun Shen1, David J Pinato2, Tsung-Hao Liu3
1Department of Medical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan; Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.
Journal of hepatology
|January 25, 2026
概括
预防性皮质类固醇可以减轻接受双重免疫检查点抑制剂 (ICI) 的不可切除肝细胞癌 (HCC) 患者的严重免疫相关不良事件. 新出现的证据表明,合理使用皮质类固醇不会影响抗瘤活性,这挑战了以前的禁令.
科学领域:
- 肝胆瘤学 肝胆瘤学
- 免疫治疗是一种免疫疗法.
- 临床药理学 临床药理学
背景情况:
- 针对CTLA-4和PD-1/PD-L1的双重免疫检查点抑制剂 (ICI) 已推进了不可切除的肝细胞癌 (HCC) 治疗.
- 严重的免疫相关不良事件 (irAEs) 限制了双重ICI治疗的临床采用,需要预防策略.
- 皮质类固醇,传统上在ICI疗法中禁用,在其他情况下 (例如,肺癌免疫化疗) 用于预防,以减少毒性.
研究的目的:
- 质疑预防性皮质类固醇 (PC) 在双重ICI疗法中已确立的禁令.
- 评估PC在减轻与双重ICI治疗相关的严重IRAE的潜力.
- 评估PC对T细胞激活和抗瘤功效在临床前和临床HCC模型中的影响.
主要方法:
- 临床前HCC研究的综述,调查皮质类固醇前期治疗对双重ICI治疗的影响.
- 对基线或同时使用皮质类固醇在ICI上HCC患者的新出现的临床数据的分析.
- 基于当前证据和临床实践的专家意见综合.
主要成果:
- 临床前研究表明,在HCC模型中,皮质类固醇前期治疗不会影响T细胞激活或双重ICI治疗诱导的抗瘤活性.
- 临床数据表明,基线或并发性皮质类固醇对接受ICI的HCC患者的瘤结局没有有害影响.
- 在接受免疫化疗但不影响疗效的肺癌患者中,PC与减少严重的irAEs有关.
结论:
- 在基于ICI的治疗中,传统的禁止PC对HCC的治疗需要重新评估.
- 谨慎使用PC可能是一个可行的策略,以减轻严重的irAEs,特别是与抗CTLA-4药物,同时保持抗瘤作用.
- 需要进行前性研究,以确定PC在高毒性ICI组合中对HCC的作用和最佳使用.
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