免疫治疗相关肝毒性的诊断与管理

Diagnosis and Management of Immunotherapy-related Liver Toxicity

  • 摘要: 免疫检查点抑制剂开启了肿瘤治疗的新时代,但随着临床应用的增加,免疫治疗相关不良反应亦不断被报道并逐渐引发关注。肝毒性是其中较常发生且具有一定致死性的严重不良反应,及早识别、诊断并对其进行恰当管理非常重要。目前国内外临床指南均对免疫治疗相关肝毒性的管理发布了指导性建议,但在肝毒性分级、激素使用剂量、激素治疗无效的后线治疗以及免疫治疗再挑战方面,仍存有较多争议和商榷空间。此外,早期识别肝毒性的发生、发现兼具灵敏度和特异度的预测指标具有重要意义。

     

    Abstract: Immune checkpoint inhibitors have revolutionized the treatment of cancer. With the increasing use of immunotherapy, clinicians have observed that immunotherapy is often related to a spectrum of adverse events. Liver toxicity is one of the most common and severe immune-related adverse events. It is very important to increase awareness and outline a clear and detailed strategy of managing immune-related liver toxicity. Some guidelines have published systematic advice on the management of immune-related liver toxicity. However, there are controversial problems remaining, including the levels of liver toxicity, the minimal effective dosage of hormone, treatments for hormone-refractory patients, and immunotherapy re-challenge. Additional, finding predictors with high specificity and sensitivity is a pressing concern.

     

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