免疫检查点抑制剂诱导的隐性进行性致命性间质性肺疾病。

IF 3 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Nobuhiro Kanaji, Naoki Watanabe, Takuya Inoue, Hitoshi Mizoguchi, Yuta Komori, Yasuhiro Ohara, Norimitsu Kadowaki
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引用次数: 0

摘要

背景/目的:免疫检查点抑制剂(ICIs)作为一种免疫相关不良事件(irAE)导致间质性肺疾病(ILDs)。ICI-ILD的特点是多种多样的。本研究的目的是探讨ICI-ILD的临床特征,特别强调隐性进行性ICI-ILD。方法:回顾性分析232例接受ICIs治疗的晚期肺癌患者(包括与细胞毒药物联合治疗)。结果:85例(36.6%)患者出现irae。最常见的irAE是ICI-ILD(41例,占所有患者的17.7%)。与非irae组相比,ICI-ILD的发生与更好的应答(应答率:88%对33%)、更长的无进展生存期(PFS)(中位数:17.5对3.0个月)和更长的总生存期(中位数:52.6对16.6个月)相关。然而,6例患者死于ICI-ILD,可分为两种模式:3例早发性ICI-ILD(中位PFS: 1.2个月)和3例隐性进展性ICI-ILD。在后一种类型中,ICI-ILD未被注意到,在不知不觉中发展,并导致呼吸衰竭(中位PFS: 7.2个月)。非组织肺炎模式和对皮质类固醇治疗的弱反应也是常见的发现。从ICI- ild可追溯识别到ICI治疗停止,平均进行了6个周期的ICI治疗。在此期间,c反应蛋白水平和ILD受累程度逐渐增加。结论:隐性进行性ICI-ILD可导致致命结果。识别出这种类型的ICI-ILD后,早期停用ICIs可能会改善患者的预后。
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 Inhibitor-Induced Insidiously Progressive, Fatal Interstitial Lung Disease.

Background/Objectives: Immune checkpoint inhibitors (ICIs) cause interstitial lung diseases (ILDs) as a type of immune-related adverse event (irAE). The characteristics of ICI-ILD are diverse. The objective of this study is to investigate the clinical features of ICI-ILD, with particular emphasis on insidiously progressive ICI-ILD. Methods: We retrospectively analyzed 232 patients with advanced lung cancer who were treated with ICIs (including combination therapy with cytotoxic agents). Results: IrAEs were observed in 85 patients (36.6%). The most frequent irAE was ICI-ILD (41 patients, 17.7% of all patients). The occurrence of ICI-ILD was associated with a significantly better response compared to the non-irAE group (response rates: 88% vs. 33%), longer progression-free survival (PFS) (median: 17.5 vs. 3.0 months), and longer overall survival (median: 52.6 vs. 16.6 months), respectively. However, six patients died from ICI-ILD, which could be divided into two patterns: early-onset ICI-ILD in three patients (median PFS: 1.2 months), and insidiously progressive ICI-ILD in three patients. In the latter type, ICI-ILD developed unnoticed, progressed insidiously, and led to respiratory failure (median PFS: 7.2 months). The non-organizing pneumonia pattern and a weak response to corticosteroid therapy were also common findings. On average, six cycles of ICI treatment were administered between the time when ICI-ILD became retrospectively recognizable and the discontinuation of ICI treatment. During this period, C-reactive protein levels and the extent of ILD involvement gradually increased. Conclusions: Insidiously progressive ICI-ILD can lead to fatal outcomes. Early discontinuation of ICIs upon recognition of this type of ICI-ILD may improve patient outcomes.

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来源期刊
Journal of Personalized Medicine
Journal of Personalized Medicine Medicine-Medicine (miscellaneous)
CiteScore
4.10
自引率
0.00%
发文量
1878
审稿时长
11 weeks
期刊介绍: Journal of Personalized Medicine (JPM; ISSN 2075-4426) is an international, open access journal aimed at bringing all aspects of personalized medicine to one platform. JPM publishes cutting edge, innovative preclinical and translational scientific research and technologies related to personalized medicine (e.g., pharmacogenomics/proteomics, systems biology). JPM recognizes that personalized medicine—the assessment of genetic, environmental and host factors that cause variability of individuals—is a challenging, transdisciplinary topic that requires discussions from a range of experts. For a comprehensive perspective of personalized medicine, JPM aims to integrate expertise from the molecular and translational sciences, therapeutics and diagnostics, as well as discussions of regulatory, social, ethical and policy aspects. We provide a forum to bring together academic and clinical researchers, biotechnology, diagnostic and pharmaceutical companies, health professionals, regulatory and ethical experts, and government and regulatory authorities.
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