免疫检查点抑制剂所致广谱毒性及其危重症的多学科联合应对

免疫检查点抑制剂(ICI)作为新型免疫治疗手段，是继化疗、靶向治疗、抗血管生成治疗后又一新兴的抗肿瘤治疗方式，已经为恶性肿瘤患者带来了显著的生存获益。但其产生的免疫相关不良反应(irAE)的总体发生率达79%～82%,irAE极大地影响了临床治疗决策，且在一定程度上限制了其临床应用和患者持续获益。几乎患者的所有器官系统都可能受到irAE的影响，其广谱性、特殊性、复杂性和多样性极大地增大了临床诊治的难度。充分认识和早期识别重度irAE对于避免发生危重症毒性相关的死亡尤为重要，危重症irAE特别需要多学科诊疗协作组(MDT)的联合应对。对诊断不明的、病情危重的、治疗效果欠佳的irAE，或者毒性缓解后是否重启免疫治疗的患者均需要规范化、标准化的MDT诊疗，故建立以患者为中心的irAE-MDT模式，以循证医学和相关指南/共识为依据，救治危重疑难irAE，将使肿瘤患者从免疫治疗中获益最大化。

Multidisciplinary management on broad-spectrum toxicity and severe toxicity caused by immune checkpoint inhibitors

As a new type of immunotherapy, immune checkpoint inhibitors (ICIs) is another emerging anti-tumor treatment modality after chemotherapy, targeted therapy, and anti-angiogenic therapy, and has brought significant survival benefits to patients with malignant tumors. However, the overall incidence of immune-related adverse events (irAEs) is 79%-82%, and irAEs greatly affect clinical treatment decisions and to some extent limit their clinical application and sustained patient benefit. Almost all organ systems can be affected by irAEs, and their universality, specificity, complexity, and diversity lead to great difficulty in diagnosis and treatment. Adequate recognition and early identification of severe irAEs is particularly important to avoid critical toxicity-related deaths, and therefore critical irAEs require treatment by a multidisciplinary team (MDT). Patients with irAEs of unknown diagnosis, critical condition, poor treatment effect, or whether to restart immunotherapy after toxic remission need standardized and standardized MDT treatment. Therefore, establishing a patient-centered irAEs-MDT model to address critical and difficult irAEs based on evidence-based medicine and guideline consensus will maximize the benefits of immunotherapy for oncology patients.