免疫检查点抑制剂和肿瘤靶向药物相关的皮肤不良反应:附22例报告
Clinical analysis of 22 cases of cutaneous adverse reactions caused by molecular targeted antitumor agents and immune checkpoint inhibitors
木葵 1周星雨 1李亚萍1
作者信息
- 1. 中南大学湘雅二医院,湖南 长沙 410000
- 折叠
摘要
目的 分析免疫检查点抑制剂(ICIs)和肿瘤靶向药物相关的皮肤不良反应.方法 回顾性分析22例免疫检查点抑制剂或各种肿瘤靶向药物相关的以皮肤表现为主的不良反应的病例相关资料.结果 22例患者发生皮肤不良反应距首次使用靶向药或ICIs的时间为1 d～4年,平均发病时间为 7 个月.CTCAE 3 级 20 例(90.91％),CTCAE 4 级 2 例(9.09％).CTCAE 3 级中 18 例(90.00％)主要表现为红斑、丘疹,3例(15.00％)累及粘膜;CTCAE 4级的2例患者均诊断为大疱表皮松解症型药疹,同时患者还有炎症指标升高、肝功能异常等表现.其中8例患者完善皮损病理检查,出现的大疱性类天疱疮、银屑病、穿通性胶原病等病理表现与特发性疾病的病理表现相似.所有患者经过抗过敏、抗炎、丙种球蛋白冲击等治疗后均好转出院.结论 免疫检查点抑制剂及靶向药导致的皮肤不良反应表现多样,住院病人中以CTCAE 3～4级为主,经过激素及常规治疗疗效较好.临床上需早发现早诊断早干预.目前暂无较好方法可以预测该不良反应的发生.
Abstract
Objective To analyze cutaneous adverse reactions induced by immune checkpoint inhibitors and targeted antitumor drugs.Methods We retrospectively analyzed the clinical data of 22 cases of cutaneous adverse reactions caused by molecular targeted antitumor agents and immune checkpoint inhibitors.Results The time between the occurrence of skin adverse reactions and the first use of targeted drugs or ICIs ranged from 1 day to 4 years,with an average of 7 months.Inpa-tients with CTCAE grades 3 and 4 accounted for 90.91％and 9.09％,respectively.Majority of CTCAE-grade 3 patients(90.00％)mainly presented with erythema and papules,and 15.00％of patients had mucous involvement.Two CTCAE-grade 4 patients were diagnosed with drug-induced bullosa epidermolysis,accompanied by elevated inflammatory markers and abnormal liver func-tion.The pathological findings of 8 patients with bullous pemphigoid,psoriasis or perforating col-lagen disease were similar to those of idiopathic diseases.All patients were discharged from hospi-tal following the treatments with anti-allergy,anti-inflammatory and intravenous immunoglobulin therapy.Conclusions The cutaneous adverse reactions induced by immune checkpoint inhibitors and targeted drugs are mainly CTCAE grades 3 and 4 in inpatients,exhibiting various manifesta-tions.Glucocorticoids and conventional treatments are effective.It is crucial to early diagnose and treat the skin adverse reactions.So far there is no good method to predict the development of drug adverse reactions.
关键词
靶向药物/免疫检查点抑制剂/皮肤不良反应Key words
targeted drug/immune checkpoint inhibitors/dermal adverse reaction引用本文复制引用
基金项目
国家自然科学基金面上项目(81472881)
长沙市自然科学基金(kq2208323)
出版年
2023
国家科技期刊平台
NSTL
维普
万方数据