肝癌免疫检查点抑制剂治疗相关不良反应及处理  

Adverse reactions associated with immune checkpoint inhibitor in treatment of liver cancer and related treatment measures

作　　者：王汉萍[1] WANG Hanping(Department of Respiratory and Critical Care Medicine,Peking Union Medical College Hospital,Beijing 100005,China)

机构地区：[1]北京协和医院呼吸与危重症医学科,北京100005

出　　处：《临床肝胆病杂志》2022年第5期985-991,共7页Journal of Clinical Hepatology

摘　　要：免疫检查点抑制剂(ICI)通过增强机体自身的抗肿瘤免疫来治疗肝癌,已经成为肝癌领域的重要治疗手段。但是,ICI激活抗肿瘤的同时,也会带来一系列特殊的毒副作用,即免疫相关不良反应(irAE)。随着ICI的广泛使用,irAE已经成为临床实践种的一项重大挑战。irAE潜在的疾病谱广泛,包括70多种不同的病理状态,其中程序性死亡受体1(PD-1)/程序性死亡受体配体1(PD-L1)抑制剂相关的irAE最常见的类型为皮肤毒性、内分泌系统毒性、肺炎以及消化道毒性等,罕见的irAE包括中枢神经系统和心血管、肾脏、血液系统等。irAE疾病谱的广泛性要求对其进行多学科的协作管理,目前国内外也已经有多个学术机构或平台制定了多个irAE管理相关的指南。然而,irAE的管理目前尚缺乏高级别前瞻性试验结果的支持,在临床上也体现出不同于各系统原有免疫病的特点,尚需进一步优化其管理。本文对于肝癌免疫治疗中出现irAE的流行病学、风险及预测因素、各系统irAE的临床特点、治疗及管理注意事项等各个方面进行详细阐述。Immune checkpoint inhibitors(ICIs)exert a therapeutic effect on liver cancer by enhancing the body’s anti-tumor immunity and have become an important treatment method in the field of liver cancer.However,while ICIs activate the anti-tumor immunity,they also bring a series of special toxic and side effects,i.e.,immune-related adverse events(irAEs).With the wide application of ICIs,irAEs have become a major challenge in clinical practice.Such irAEs have a wide potential disease spectrum and include more than 70 different pathological states,and the most common types of irAEs associated with PD-1/PD-L1 inhibitors are skin toxicity,endocrine toxicity,pneumonia,and digestive tract toxicity,while rare irAEs include the toxicity of the central nervous system and the cardiovascular,renal,and blood systems.The wide disease spectrum of irAEs requires multidisciplinary collaborative management,and at present,many academic institutions or platforms in China and globally have formulated various guidelines for irAE management.However,the management of irAEs currently lacks the support of the results of high-level prospective trials,and the characteristics of irAEs are different from the original immune diseases of various systems;therefore,its management needs to be further optimized.This article elaborates on the epidemiology of irAEs in immunotherapy for liver cancer,related risk and predictive factors,clinical features of irAEs involving different systems,and precautions for treatment and management.

关 键 词：肝肿瘤 免疫抑制剂 药物相关性副作用和不良反应 

分 类 号：R73[医药卫生—肿瘤]