免疫检查点抑制剂和神经毒性:多学科方法的诊断和管理重点。

IF 3 3区 医学 Q2 PHARMACOLOGY & PHARMACY
Expert Opinion on Drug Safety Pub Date : 2024-11-01 Epub Date: 2024-06-03 DOI:10.1080/14740338.2024.2363471
Desirèe Speranza, Mariacarmela Santarpia, Francesco Luppino, Fausto Omero, Enrica Maiorana, Mariacarmela Cavaleri, Elena Sapuppo, Vincenzo Cianci, Alessia Pugliese, Vito Racanelli, Giulia Maria Camerino, Carmelo Rodolico, Nicola Silvestris
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引用次数: 0

摘要

简介尽管免疫检查点抑制剂(ICIs)给癌症治疗带来了革命性的变化,但随之而来的免疫系统过度激活往往会因不良反应而变得复杂,这些不良反应可能会影响包括神经系统在内的多个器官和系统。神经系统不良反应(n-irAEs)的确切病理生理学尚不完全清楚。接受抗 CTLA-4 药物治疗的患者中约有 3.8%、接受抗 PD-1/PD-L1 治疗的患者中约有 6.1%、接受联合治疗的患者中约有 12% 出现了 n-irAEs。大多数 n-irAEs 是低级别的,而严重毒性很少见报道。在本文中,我们在主要医学研究数据库中进行了关于免疫相关神经毒性的最新文献检索,检索时间为 2017 年 2 月至 2023 年 12 月:我们还比较了最新的国家和国际 n-irAEs 管理指南,以便更好地确定患者管理方法:专家意见:在免疫治疗期间,对肿瘤患者的管理似乎需要采用多学科方法。因此,为了更好地处理这些毒性反应,我们认为有必要与擅长诊断和治疗 n-irAEs 的神经科医生合作,而且在开始免疫疗法之前有必要对中枢和外周神经系统进行全面评估,并在治疗期间定期进行复查。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Immune checkpoint inhibitors and neurotoxicity: a focus on diagnosis and management for a multidisciplinary approach.

Introduction: Although immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment, the consequential over activation of the immune system is often complicated by adverse events that can affect several organs and systems, including the nervous system. The precise pathophysiology underlying neurological irAEs (n-irAEs) is not completely known. Around 3.8% of patients receiving anti-CTLA-4 agents, 6.1% of patients receiving anti-PD-1/PD-L1, and 12% of patients receiving combination therapies have n-irAEs. Most n-irAEs are low-grade, while severe toxicities have rarely been reported. in this article, we performed an updated literature search on immuno-related neurotoxicity on main medical research database, from February 2017 to December 2023.

Areas covered: We have also compared the latest national and international guidelines on n-irAEs management with each other in order to better define patient management.

Expert opinion: A multidisciplinary approach appears necessary in the management of oncological patients during immunotherapy. Therefore, in order to better manage these toxicities, we believe that it is essential to collaborate with neurologists specialized in the diagnosis and treatment of n-irAEs, and that a global neurological assessment, both central and peripheral, is necessary before starting immunotherapy, with regular reassessment during treatment.

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来源期刊
CiteScore
5.90
自引率
3.20%
发文量
97
审稿时长
6-12 weeks
期刊介绍: Expert Opinion on Drug Safety ranks #62 of 216 in the Pharmacology & Pharmacy category in the 2008 ISI Journal Citation Reports. Expert Opinion on Drug Safety (ISSN 1474-0338 [print], 1744-764X [electronic]) is a MEDLINE-indexed, peer-reviewed, international journal publishing review articles on all aspects of drug safety and original papers on the clinical implications of drug treatment safety issues, providing expert opinion on the scope for future development.
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