免疫检查点抑制剂治疗中胃肠道毒副反应的管理

Management of gastrointestinal adverse reaction induced by immune checkpoint inhibitors

免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)是一类新兴的抗肿瘤药物,它能极大程度的改善晚期癌症患者的临床预后,提高患者的生存率。ICIs通过阻断T细胞表面的共抑制受体来激活免疫系统,以发挥抗肿瘤的作用。但是在发挥其卓越治疗作用的同时,也可能会给患者带来许多不良反应,称为:免疫相关不良事件(immune-related adverse events,ir AEs)。胃肠道毒性反应作为第二大高发的ICIs引发的ir AEs,可对患者造成极其严重的影响,危重时甚至可导致患者死亡。ICIs诱导的胃肠道毒性反应种类繁多,最常见的反应为腹泻和胃肠道炎症。我们将重点了解ICIs类药物的作用机制、发生胃肠道毒性反应患者的临床症状及辅助检查结果,以便临床中及早的发现并诊断,方便管理与治疗。以期最大限度的在避免毒性反应的同时发挥ICIs的治疗作用。

Immune checkpoint inhibitors(ICIs) are a new class of anticancer drugs that can greatly improve the clinical prognosis of patients with advanced cancer and improve their survival.ICIs activates the immune system by blocking co-repressor receptors on the surface of T cells to exert an anti-tumor effect.However,while exerting its excellent therapeutic effects,it may also bring many side effects to patients,which means immune-related adverse events(irAEs).As the second most frequent irAEs triggered by ICIs,gastrointestinal toxicity can have extremely serious effects on the patient,even leading to death.There are a wide variety of ICIs-induced gastrointestinal toxicity reactions.The most common reactions are diarrhea and gastrointestinal inflammation.We focus on understanding the mechanism of action of ICIs drugs and the performance of gastrointestinal toxicity,in order to early detect and diagnose,as well facilitate clinical management and treatment,and maximize the therapeutic effect of ICIs while avoiding toxic reactions.