肿瘤免疫检查点抑制剂治疗相关性肝损伤诊疗进展及存在的问题
Progress and problems in the diagnosis and treatment of immune checkpoint inhibitor related liver injury in cancer
王凯峰 1彭忠忠 2张西凯 2周晓 2苗贤媛 2王琼琼 2任思家 2张柏文 1王艺 1马越1
作者信息
- 1. 上海交通大学医学院附属仁济医院肿瘤科,上海 200127
- 2. 宁波市杭州湾医院肿瘤科,浙江 宁波 315336
- 折叠
摘要
肿瘤免疫检查点抑制剂(immune checkpoint inhibitor,ICI)产生的免疫相关性不良反应(immune-related adverse events,irAE)已经引起临床专家的重视.ICI相关性肝损伤(immune-mediated liver injury caused by ICIs,ILICI)在临床上并不少见,有其自身的特点,但缺乏特异性的诊断方法,且存在较多亟需解决的问题.开展活检为主的相关检测,有助于判断并优化免疫相关毒性的管理.在ILICI治疗方面,证据表明并不一定要尽快予皮质类固醇治疗,需要在疗效、毒性和特定治疗需求之间取得平衡并通过多学科诊疗(multidisciplinary team,MDT)加以完善.未来应考虑采用合适的ICI剂量及寻找预测靶点,以期降低ILICI的发生率和严重程度,同时需要进行深入的基础研究来阐明ILICI潜在的病理生理机制和风险因素.随着临床循证依据的不断完善及研究的深入,ILICI的诊治水平也将与时俱进,不断提高.
Abstract
The immune related adverse events(irAE)caused by tumor immune checkpoint inhibitors(ICI)have attracted increasing attention of clinical experts.Immune-mediated liver injury caused by ICIs(ILICI)is not uncommon in clinical practice,but specific diagnostic method of ILICI is lacking.Biopsy of liver tissue can help improve the diagnosis and management of ILICI.In the treatment of ILICI,the immediate use of corticosteroid therapy is not necessarily.A balance between efficacy,toxicity,and specific treatment need to be achieved,and further refined through multidisciplinary team(MDT)cooperation.Appropriate dosaging and identification of novel predictive targets should be considered in order to reduce the incidence and severity of ILICI in the future.Meanwhile,further basic research is required to elucidate the potential pathophysiological mechanisms and risk factors of ILICI.With the refinement of evidence in clinical evidence-based medicine and deepening of basic research,the diagnosis and treatment level of ILICI will also be further improved.
关键词
恶性肿瘤/免疫检查点抑制剂/肝损伤/ICIs相关性肝损伤Key words
Malignant tumors/Immune checkpoint inhibitor/Liver injury/Immune-mediated liver injury caused by ICIs引用本文复制引用
出版年
2024
NETL
NSTL
万方数据