免疫检查点抑制剂相关神经不良反应诊治中国专家共识(2022版)

Chinese expert consensus on diagnosis and treatment of neurologic immune-related adverse events associated with immune checkpoint inhibitors(2022 edition)

神经免疫相关不良事件(NAEs)是免疫检查点抑制剂(ICI)的罕见并发症,可影响中枢神经系统、周围神经系统和神经内分泌系统等,重者可导致死亡和严重的功能障碍,需要临床医师的高度重视和合理规范诊治。因NAEs复杂性、多样性和部分非特异性的临床表现,NAEs诊断需与肿瘤、感染、代谢和医源性(非免疫介导)并发症等其他疾病导致的神经功能障碍仔细鉴别。中国抗癌协会肿瘤支持治疗专业委员会和中国抗癌协会肿瘤临床化疗专业委员会就NAEs的相关临床重点问题如NAEs的流行病学、发病机制、风险因素、诊断和治疗的一般原则、特定类型NAEs的临床表现、诊治策略及NAEs后ICI再挑战治疗的原则等,组织专家进行文献检索和分析讨论,基于目前临床证据并结合中国临床实际,对NAEs的预防、诊断、综合治疗及随访等相关问题制定形成免疫检查点抑制剂的神经不良反应诊治中国专家共识(2022版),以期指导临床实践。

Neurologic immune-related adverse events(NAEs)are rare complications of immune checkpoint inhibitors(ICI).NAEs can affect the central nervous system,peripheral nervous system and neuroendocrine system,they can lead to death and serious dysfunction.NAEs requires standardized diagnosis,treatment and clinicians′high attention.The diagnosis of NAEs is very challenging due to its complexity,diversity and some non-specific clinical manifestations.It needs to be carefully distinguished from neurological dysfunction caused by other diseases such as tumor,infection,metabolism and iatrogenic(non-immune mediated)complications.Therefore,Committee of Neoplastic Supportive-Care of China Anti-Cancer Association and Cancer Clinical Chemotherapy Committee of China Anti-Cancer Association organized experts to conduct literature analysis and evidence level discussion on the clinical key issues related to NAEs,including the epidemiology,pathogenesis,risk factors,general principles of diagnosis and treatment,clinical manifestations and diagnosis and treatment strategies of specific types of NAEs,and the principles of ICI rechallenge after NAEs.Based on the latest clinical evidence and combined with China′s clinical practice,the expert committee finally formulated a Chinese expert consensus on diagnosis and treatment of nAEs(2022 edition)for the prevention,diagnosis,comprehensive treatment and follow-up of NAEs.