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«Practical Oncology» Том 2, №3, 2019

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Immune-related adverse events associated with cancer immunotherapy

Authors: Головач И.Ю. (1), Егудина Е.Д. (2)
1 - Клиническая больница «Феофания» Государственного управления делами, г. Киев, Украина
2 - Клиника современной ревматологии, г. Киев, Украина

Categories: Oncology

Sections: Specialist manual

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Summary

Імунотерапія ознаменувала настання нової ери в онкології. Інгібітори імунних контрольних точок (іІКТ) підсилюють протипухлинний імунітет, активізуючи імунну систему пацієнта для боротьби з раком. Показано, що ці агенти мають більш високий профіль безпеки, ніж хіміотерапія. Незважаючи на те, що терапія цим класом препаратів призвела до поліпшення клінічних результатів у пацієнтів із множинними типами пухлин, на тлі терапії іІКТ розвивається широкий спектр імунозалежних побічних ефектів (ІЗПЕ), що зачіпають будь-яку систему органів, з різними клінічними проявами. Більшість токсичних ефектів є зворотними, але оперативне розпізнавання і лікування ІЗПЕ асоційовані з поліпшенням результатів терапії іІКТ і являють собою важливе нове клінічне завдання для практикуючих онкологів. В даному літературному огляді наведені найбільш поширені і клінічно важливі ІЗПЕ з описом їх епідеміології, клінічних проявів і лікування. Оскільки імунотерапія на сьогодні все ширше використовується в клінічній практиці, вкрай важливо міждисциплінарне співробітництво онкологів з ревматологами, пульмонологами, ендокринологами, гематологами, нефрологами, окулістами і дерматологами для ранньої діагностики і оптимального менеджменту. Також розглянуті майбутні стратегії, що можуть дати змістовне уявлення про профілактику і менеджмент ІЗПЕ.

Иммунотерапия ознаменовала наступление новой эры в онкологии. Ингибиторы иммунных контрольных точек (иИКТ) усиливают противоопухолевый иммунитет, активизируя иммунную систему пациента для борьбы с раком. Показано, что эти агенты имеют более высокий профиль безопасности, чем химиотерапия. Несмотря на то что терапия этим классом препаратов привела к улучшению клинических результатов у пациентов с множественными типами опухолей, на фоне терапии иИКТ развивается широкий спектр иммунозависимых побочных эффектов (ИЗПЭ), затрагивающих любую систему органов, с различными клиническими проявлениями. Большинство токсических эффектов являются обратимыми, но оперативное распознавание и лечение ИЗПЭ ассоциированы с улучшением результатов терапии иИКТ и представляют собой важную новую клиническую задачу для практикующих онкологов. В данном литературном обзоре представлены наиболее распространенные и клинически важные ИЗПЭ с описанием эпидемиологии, клинических проявлений и лечения. Поскольку иммунотерапия в настоящее время все шире используется в клинической практике, крайне важно междисциплинарное сотрудничество онкологов с ревматологами, пульмонологами, эндокринологами, гематологами, нефрологами, окулистами и дерматологами для ранней диагностики и оптимального менеджмента. Также рассмотрены будущие стратегии, которые могут дать содержательное представление о профилактике и менеджменте ИЗПЭ.

Immunotherapy marked the onset of a new era in oncology. Immune checkpoint inhibitors enhance anti-tumor immunity by activating the patient’s immune system to fight cancer. It has been shown that these agents have a higher safety profile than chemotherapy. And despite the fact that therapy with this class of drugs has led to an improvement of clinical results in patients with multiple types of tumors, a wide range of immune-related adverse events with various clinical manifestations affecting any organ system develops on the background of immune checkpoint inhibitor therapy. Most of the toxic effects are reversible, but the prompt recognition and treatment of immune-related adverse events is associated with improved outcomes of immune checkpoint inhibitor therapy and represents an important new clinical challenge for practicing oncologists. This literature review presents the most common and clinically important immune-related adverse events, with epidemiology, clinical presentation, and treatment. As immunotherapy is currently being increasingly used in clinical practice, the interdisciplinary cooperation of oncologists with rheumatologists, pulmonologists, endocrinologists, hematologists, nephrologists, ophthalmologists and dermatologists is extremely important for early diagnosis and optimal management. Future strategies that can provide a meaningful insight into the prevention and management of immune-related adverse events are also considered.


Keywords

інгібітори імунних контрольних точок; імунозалежні побічні ефекти; імунотерапія; імунні токсичні ефекти; менеджмент

ингибиторы иммунных контрольных точек; иммунозависимые побочные эффекты; иммунотерапия; иммунные токсические эффекты; менеджмент

immune checkpoint inhibitors; immune-related adverse events; immunotherapy; immune-related toxicities; management


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