罕见的免疫相关不良事件(irAEs):诊断和管理方法。

IF 3.1 Q2 PHARMACOLOGY & PHARMACY
Pharmaceutical Medicine Pub Date : 2024-01-01 Epub Date: 2024-01-09 DOI:10.1007/s40290-023-00508-5
Anadil Javaid, Catherine Bennett, Aparna Rao, Lavinia Spain
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引用次数: 0

摘要

免疫检查点抑制剂(ICIs)彻底改变了许多实体器官恶性肿瘤的治疗格局,并已成为许多肿瘤常规临床实践的一部分。随着单药治疗、双药治疗以及与化疗和靶向药物联合治疗的适应症不断扩大,临床医生必须了解可能出现的各种免疫相关不良事件(irAEs)。常见的毒性反应包括皮疹、结肠炎、肝炎和肺炎,这些在文献中都有详细描述,并有成熟的诊断和管理算法。较罕见的毒性反应通常发生率低于 1%,但定义较少。这些综合征的识别率可能很低,可能会发展成急性病程,而且没有成熟的或以证据为基础的诊断和管理策略。因此,患者的发病率、死亡率和预后可能会增加,这既与这些非器质性病变有关,也与这些病变的治疗如何影响其潜在恶性肿瘤的治疗有关。在这篇综述中,我们旨在探讨一些不常见虹膜AEs的发病率、潜在生物标志物、发病机制、诊断工作和临床后遗症,重点是心肌炎、神经和血液综合征。需要进一步开展前瞻性研究,以准确界定这些病症的发病率和发病机制,从而提高临床医生对罕见虹膜急性心动过速的认识,并协助采用更加个性化和基于机制的方法来治疗这些综合征。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rare Immune-Related Adverse Events (irAEs): Approach to Diagnosis and Management.

Immune checkpoint inhibitors (ICIs) have revolutionised the treatment landscape across many solid organ malignancies and form part of routine clinical practice in many tumours. As indications for monotherapy, doublet therapy and combination approaches with chemotherapy and targeted agents expand, clinicians must be aware of the wide range of possible immune-related adverse events (irAEs). Common toxicities, including rash, colitis, hepatitis and pneumonitis are well described in the literature, and have established diagnostic and management algorithms. Rarer toxicities, often with an incidence of less than 1%, are less defined. These syndromes can be poorly recognised, may take on a fulminant course and do not have established or evidence-based diagnostic and management strategies. As such, patients may experience increased morbidity, mortality and poorer outcomes, related both to these irAEs as well as how the treatment of these may affect the management of their underlying malignancy. In this review, we aim to explore the incidence, potential biomarkers, pathogenesis, diagnostic work-up and clinical sequelae of a selection of uncommon irAEs, with a focus on myocarditis, neurological and haematologic syndromes. Further prospective research is required to accurately define the incidence and pathogenesis of these conditions, with the aim of increasing clinician awareness of rare irAEs and to assist with a more personalised and mechanism-based approach to these syndromes.

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来源期刊
Pharmaceutical Medicine
Pharmaceutical Medicine PHARMACOLOGY & PHARMACY-
CiteScore
5.10
自引率
4.00%
发文量
36
期刊介绍: Pharmaceutical Medicine is a specialist discipline concerned with medical aspects of the discovery, development, evaluation, registration, regulation, monitoring, marketing, distribution and pricing of medicines, drug-device and drug-diagnostic combinations. The Journal disseminates information to support the community of professionals working in these highly inter-related functions. Key areas include translational medicine, clinical trial design, pharmacovigilance, clinical toxicology, drug regulation, clinical pharmacology, biostatistics and pharmacoeconomics. The Journal includes:Overviews of contentious or emerging issues.Comprehensive narrative reviews that provide an authoritative source of information on topical issues.Systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by PRISMA statement.Original research articles reporting the results of well-designed studies with a strong link to wider areas of clinical research.Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in Pharmaceutical Medicine may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.All manuscripts are subject to peer review by international experts. Letters to the Editor are welcomed and will be considered for publication.
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