ASCO/NCCN免疫治疗毒性管理指南解读

Comments on ASCO/NCCN management guidelines of toxicities from immunotherapy

随着免疫检查点抑制剂在肿瘤治疗中的应用迅速增多,其不良反应的处理逐渐成为临床实践的重要内容。2017年,欧洲临床肿瘤协会(European Society for Medical Oncology,ESMO)率先发表了《免疫治疗的毒性管理:ESMO诊断、治疗和随访临床实践指南》,为肿瘤科医生对不良反应的管理带来了极大的帮助。随着临床经验和证据的不断积累,2018年,美国临床肿瘤学会(American Society of Clinical Oncology,ASCO)联合美国国家综合癌症网络(National Comprehensive Cancer Network,NCCN)发表了《免疫检查点抑制剂治疗相关毒性的管理指南》,更加系统地介绍和讨论了不良反应的管理流程。本解读将简要介绍ASCO/NCCN指南的内容,并对比其与ESMO指南的差异,以期为不良反应的管理带来更深层次的理解。

Immune checkpoint inhibitors （ICPis） have been used in an increasing number of cancer patients. The management of immune related toxicities has become a common situation that oncologists may be faced with. European Society for Medical Oncology （ESMO） published Management of toxicities from immunotherapy： ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-upin 2017, which provided significant help for oncologist to deal with ICPi-related toxicities. Recently, American Society of Clinical Oncology （ASCO） has developed ASCO/National Comprehensive Cancer Network （NCCN） toxicity management guideline in collaboration with NCCN, in which more detailed strategies have been recommended for specific organ- and system-based toxicity diagnosis and management. Here, the ASCO/NCCN guideline will be introduced briefly. We will also compare these two guidelines in aspects of identifying patients at risk, diagnosis and differential diagnosis, treatment strategies and re-challenging with ICPis, hoping to get a thorough and in-depth understanding of managing immune-related toxicities.