免疫检查点抑制剂的内分泌毒性及临床应对策略

Endocrine toxicity of immune checkpoint inhibitors and clinical response strategies

以细胞毒性T淋巴细胞相关抗原4(cytotoxic T lymphocyte⁃associated antigen⁃4,CTLA⁃4)和免疫检查点程序性死亡蛋白1(programmed cell death protein 1,PD⁃1)/程序性死亡分子配体1(programmed death⁃ligand 1,PD⁃L1)抗体为代表的免疫检查点抑制剂(immune checkpoint inhibitor,ICPIs)作为一种新型恶性肿瘤治疗药物,在临床上对多种肿瘤都具有良好的治疗效果。然而,这些药物在使用的过程中被发现可产生广泛的免疫相关性不良反应(immune⁃related adverse events,irAEs),其中内分泌器官的损害较为常见,不同程度影响患者的抗肿瘤治疗效果及生存质量。本文综述了ICPIs治疗的免疫相关不良反应的临床特点、可能的发病机制及处理策略。

Immune checkpoint inhibitors(ICPIs)including anti⁃cytotoxic T lymphocyte antigen 4,anti⁃programmed cell death 1 and anti⁃programmed cell death 1 ligand antibodies are novel therapeutic agents targeting a variety of cancers and show good therapeutic effect in clinical practice.However,a wide range of immune⁃related adverse reactions(irAEs)are reported during their application,during which the endocrine organ damage is the most common,and it affects the anti⁃tumor effect and patient′s quality of life.This article reviews the clinical char⁃acteristics,possible pathogenesis and management strategies of immune⁃related adverse reactions of ICPIs therapy.