肿瘤免疫治疗相关不良反应研究进展

免疫检查点抑制剂(ICIs)改变了肿瘤治疗格局,因其独特的作用机制,产生的免疫治疗相关不良反应(irAEs)可涉及全身各个器官系统,需严密监测及特殊处理。因此,美国临床肿瘤协会、欧洲肿瘤学会、美国国立综合癌症网络及中国临床肿瘤协会均发布免疫治疗相关不良事件的共识或指南。本文从irAEs病理生理机制、受累系统、治疗选择及ICIs挑战再挑战4个方面进行综述。     

肿瘤免疫治疗相关动脉粥样硬化的研究进展

免疫检查点抑制剂(ICI)的应用改善了多种肿瘤的疗效和预后,然而其特有的免疫相关不良事件,尤其是心脏毒性受到关注。最近的研究发现ICI治疗可能通过促进动脉慢性炎症导致或加重动脉粥样硬化,机制尚不十分明确。现重点对ICI相关动脉粥样硬化的流行病学、病理生理机制、影像学特征和药物治疗方面的进展进行综述,旨在提高临床医生对该心血管免疫相关不良事件的认识和诊疗水平。     

免疫检查点抑制剂治疗肝细胞癌相关不良反应及管理

免疫检查点抑制剂的应用显著提高了多种实体瘤的免疫治疗效果。随着Nivolumab和Pembrolizumab被美国食品药品监督管理局批准用于肝癌的二线治疗,免疫检查点抑制剂,特别是与其他治疗方法的联合应用在肝细胞癌中的应用也越来越广泛。这些药物在接触肿瘤的免疫抑制作用发挥治疗作用的同时,也激发了自身免疫引起的相关副作用...     

食管癌免疫治疗研究进展

免疫治疗是近年来肿瘤治疗领域的热点,在各个瘤种中均进行了广泛的探索性研究。本文对食管癌免疫治疗的相关研究进展进行综述,全面分析免疫检查点抑制剂在食管癌中的治疗效果,同时寻找能够预测治疗效果的分子生物学标记。以食管癌、免疫治疗、免疫检查点抑制剂为关键词进行文献检索,共检索中文文献6篇,英文文献27篇,排除10篇,最终对23篇文献进行分析。在NCCN治疗指南中,错配修复蛋白缺失突变(dMMR)和微卫星高度不稳定(MSI-H)的患者应用PD-1单抗是晚期食管癌的标准二线治疗。无论是免疫单药、免疫联合治疗在食管癌一线、二线以及新辅助治疗中都进行了尝试。免疫治疗在食管癌治疗中显示出一定的生存获益,筛选能够预测免疫检查点抑制剂疗效的生物学标记物是提高疗效的关键。     

免疫检查点抑制剂引起的内分泌系统免疫相关不良反应专家共识(2020)

免疫检查点抑制剂(immune checkpoint inhibitors,ICPis)通过阻断免疫抑制分子,重新激活效应T细胞特异性杀伤肿瘤细胞的功能,发挥抗肿瘤作用。ICPis通过调控免疫应答杀伤肿瘤的同时,过度活化的免疫细胞也可能导致机体产生自身免疫损伤,即免疫相关不良反应(immune-related adverse events,irAEs)。内分泌不良反应是最为常见的不良反应之一,主要涉及垂体、甲状腺、胰腺、肾上腺等内分泌腺体,引起相应的内分泌功能紊乱。ICPis致内分泌腺体损伤是临床医学技术发展带来的新问题,很多临床医生对其诊治存在诸多疑惑。国内外虽已陆续推出多个指南/共识,但目前国内尚无针对ICPis引起的内分泌系统免疫相关不良反应的诊治流程和共识。为规范和提高临床诊治水平,中华医学会内分泌学分会免疫内分泌学组组织专家根据国内外专家共识和相关临床研究,综合肿瘤学、免疫学专家意见后撰写制订本共识,以供在临床实践和临床研究中参考。     

免疫检查点抑制剂治疗相关胃肠道不良反应的临床诊疗管理

免疫检查点抑制剂(ICI)是一种新型的抗肿瘤药物,可有效提高肿瘤患者生存率,在肿瘤治疗中发挥着越来越重要的作用。然而,在ICI的使用过程中,不少患者出现了严重程度不一、累及器官不同的不良反应,其中胃肠道不良反应作为次常见的多发免疫相关不良反应备受关注。本文介绍了ICI治疗相关胃肠道不良反应的发生率、诊断、治疗和前沿进展...     

预测心肌梗死后不良心血管事件的血液生物学标志物研究进展

心肌梗死后主要不良心血管事件(major adverse cardiac events,MACEs)不仅降低患者的生活质量,而且增加患者的死亡风险.及时进行血液生物学标志物检测,可预测心肌梗死后MACEs的发生,以便有针对性地开展防治.本文对预测心肌梗死后MACEs发生的血液生物学标志物的研究进展进行概述.这些血液生物...     

Citrate anticoagulation and adverse events

Several patients with heparin intolerance were dialysed with tri-sodium citrate as anticoagulant without acute clinical problems (good tolerance). After some weeks however problems arose. In all patients an alkalosis developed: the pre dialysis bicarbonate level rose progressively from 27 mmol/l to 40 mmol/l. This could be tempered by lowering the dialysis fluid bicarbonate concentration from 37 mmol/l to 25 mmol/l. A second problem was a progressive rise in pre dialysis sodium level from a mean of 136 mmol/l to 150 mmol/l. Adapting the dialysis fluid sodium concentration from 140 mmol/l towards 132 mmol/l could solve this. The third problem was a progressive rise in serum aluminium level in patients from 3 microg/l to 38 microg/l. After excluding water, concentrate, dialysis fluid, drug intake, etc... as possible sources, we controlled the aluminium level in the glass bottle containing tri-sodium citrate. We noted the very high value of 35,300 microg/l. After replacing the glass bottles with polyvinylchloride bags with a negligible aluminium content, the serum aluminium levels returned back to normal. It is known that citrate chelates the aluminium present in the glass of bottles or vials.     

Risk of adverse events with fibrates

An increased risk for adverse events was observed with gemfibrozil relative to fenofibrate, predominantly driven by an increased rate of rhabdomyolysis. This difference was especially noticeable in patients taking the combination of gemfibrozil and a statin, particularly cerivastatin.     

The epidemiology of glucocorticoid-associated adverse events

PURPOSE OF REVIEW: The introduction of glucocorticoid therapy by Dr Philip Hench in the 1950s revolutionized the treatment of rheumatic and inflammatory disease. These preparations remain an important component of therapy for a variety of diseases. As with any potent medication, however, they are not without side effects. Analysis of physician understanding and practice suggest that appreciation for the frequency and significant morbidity associated with glucocorticoids is poor. The purpose of this review is to provide an update on the most recent literature regarding glucocorticoid use and associated adverse events. RECENT FINDINGS: Recent studies suggest that adverse events such as weight gain, skin thinning, sleep disturbance and neuropsychiatric disorders may occur in patients taking glucocorticoids. Adverse events may occur even in low-dose therapy and appear to be dose and duration dependent. Glucocorticoid-induced osteoporosis is a potentially preventable complication but physician adherence to preventive guidelines is poor. New data reinforce the understanding that glucocorticoids significantly increase the risk of infection. There are strong data-driven concerns about the increased susceptibility of children and possibly even neonates to glucocorticoid-associated adverse events. SUMMARY: Glucocorticoid therapy, while important in the treatment of a variety of serious inflammatory diseases, causes significant morbidity among long term users.