肿瘤免疫治疗毒性管理难点  

Diffi cult issues in management of immunotherapy-related toxicity for cancer patients

作　　者：关雅萍 王俊[1] Guan Yaping;Wang Jun(Department of Oncology,the First Affiliated Hospital of Shandong First Medical University&Shandong Provincial Qianfoshan Hospital,Shandong Key Laboratory of Rheumatic Disease and Translational Medicine,Shandong Lung Cancer Institute,Jinan 250014,China)

机构地区：[1]山东第一医科大学第一附属医院(山东省千佛山医院)肿瘤中心,山东风湿疾病与转化医学重点实验室,山东省肺癌研究所,山东济南250014

出　　处：《实用肿瘤杂志》2022年第6期490-494,共5页Journal of Practical Oncology

基　　金：国家自然科学基金面上项目(81572875);山东省自然科学基金面上项目(ZR202102190539);CSCO领航肿瘤研究基金项目(Y-2019AZMS-0440);CSCO默沙东肿瘤研究基金项目(Y-MSD2020-0350);吴阶平医学研究基金项目(320.6750.2020-12-16)。

摘　　要：以免疫检查点抑制剂为主的免疫治疗已经成为实体瘤治疗的主要手段,广谱且有效,改变了肿瘤治疗的格局,但随之产生的毒性,或称为免疫相关不良反应(immune-related adverse events,irAEs),越来越成为免疫治疗的障碍。目前,多部国内外指南或共识对irAEs的诊断、分级、治疗和监测提出了原则性和针对性的指导意见,但重症、难治性和少见irAEs时有发生,难以预测,无确诊金标准,且往往涉及多学科策略,是临床管理的重点和难点。本文将围绕免疫治疗的难点问题展开论述,包括毒性的预防与预测、毒性的鉴别诊断、重症和难治性毒性的管理、免疫抑制剂的应用及毒性的监测。Immunotherapy based on immune checkpoint inhibitors has become the main treatment approach for human solid tumors,which is extremely broad-spectrum and effective,and has changed the clinical pattern of cancer treatment.However,the toxicity,termed as immune-related adverse events(irAEs),has increasingly presented as an obstacle to immunotherapy.At present,several domestic and in-ternational guidelines or consensus have provided principled guidance on the diagnosis,classification,treatment,and monitoring of irAEs.However,severe,refractory and rare irAEs occur from time to time,and are hard to predict and diagnose due to a lack of gold standards,and management of these irAEs often involve multidisciplinary strategies.This article will focus on the difficult issues of immunotherapy for cancer patients,including prevention and prediction of toxicity,differential diagnosis of toxicity,management of severe and refractory tox-icity,application of immunosuppressive agents,and monitoring of toxicity.

关 键 词：免疫检查点抑制剂 免疫相关不良反应 难点 

分 类 号：R730.51[医药卫生—肿瘤]