Diagnosis and Management of Rare Immune-Related Adverse Events.

Autor: Schoenfeld SR; Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Aronow ME; Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA., Leaf RK; Division of Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Dougan M; Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA., Reynolds KL; Division of Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: The oncologist [Oncologist] 2020 Jan; Vol. 25 (1), pp. 6-14. Date of Electronic Publication: 2019 Nov 06.
DOI: 10.1634/theoncologist.2019-0083
Abstrakt: Oncologic treatment is being revolutionized by a burgeoning number of immune checkpoint inhibitors (ICPis). To date, seven ICPis have received Food and Drug Administration approval, targeting cytotoxic T-lymphocyte antigen, programmed cell death, or programmed cell death ligand. Adverse events associated with checkpoint inhibition have been described in the literature. Guidelines exist for the most common of these, but as the use of ICPis becomes more common, the number of patients presenting with rare events will increase. This article reviews the diagnosis and management of rare ocular, hematological, luminal gastrointestinal, and rheumatological toxicities arising from ICPi treatment. KEY POINTS: As the use of immune checkpoint inhibitors (ICPis) becomes more common, the number of rare immune-related adverse events (irAEs) will increase. A high level of suspicion is required to identify and treat these toxicities. Although it can be difficult to definitively attribute rare irAEs to ICPis, a temporal and mechanistic relationship and the absence of other etiologies should make the treating physician suspicious for a rare irAE. Certain rare irAEs, such as celiac disease, do not require treatment with glucocorticoids. Thus, differentiating this irAE from other gastrointestinal irAEs has important implications for treatment.
(© AlphaMed Press 2019.)
Databáze: MEDLINE
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