免疫检查点抑制剂致多系统免疫相关不良事件的诊疗思路

Ideas for the Diagnosis and Treatment of Multisystem Immune-related Adverse Events Caused by Immune Checkpoint Inhibitors

免疫检查点抑制剂(ICIs)作为一类新型抗癌疗法改变了多种癌症的治疗格局。然而,ICIs存在许多潜在的并发症,称之为免疫相关不良事件(irAEs),可能涉及神经系统、心脏系统、肺系统、皮肤系统、肾脏系统、胃肠系统、肝脏系统和血液系统等。尽管国内外已出台了一系列irAEs管理指南,但是临床医生对此疾病的认知水平和重视程度不同,在临床工作中对irAEs的早期识别、诊断及治疗还不够规范。本文报道了1例使用信迪利单抗治疗后患者出现严重的多系统irAEs的临床资料,结合相关文献对病例进行分析,总结值得借鉴的经验以及存在的局限,为临床医生更好地处理多系统irAEs提供思路。

As a new type of anti-cancer therapy,immune checkpoint inhibitors(ICIs)have transformed the treatment of various cancers.However,ICIs are associated with many potential complications,namely immune-related adverse events(irAEs),possibly involving the nervous,cardiac,pulmonary,cutaneous,renal,gastrointestinal,hepatic,and hematologic systems.Although a series of guidelines for the management of irAEs have been issued,early identification,diagnosis and treatment of irAEs in clinical practice are still not standardized enough due to different levels of awareness and attention regarding the disease across clinicians.We analyzed the clinical data of a patient with severe multisystem irAEs developed after treatment with cindilimab,and reviewed relevant literature,then summarized the benefits and limitations of treatments for irAEs,providing ideas for better managing multisystem irAEs clinically.