Öz
İmmünoterapiler son zamanlarda bir çok kanser tipinde ( küçük hücreli olmayan akciğer ca, renal hücreli ca, malign melanom, hodgkin lenfoma gibi) tedavide önemli rol oynamaktadır. İmmüncheckpoint inhibitörleri (ir) reseptörlerine bağlandıklarında tümör dokusunda hücrelerin aşırı yanıt vermesini sağlayan sinyalleri önler ve inflamatuar yanıt sürecinde oluşan doku hasarını sınırlar. Bu tedaviyi alan hastaların Acil Servis başvuruları da tedavinin yaygınlığı arttıkça artmaktadır. irAE çok geniş bir spektrumu içermektedir. Kardiyak yan etkiler-myokardit ve buna bağlı oluşabilecek disritmiler, akut koroner sendrom, perikardiyal sıvı ve perikardit; torasik yan etkiler- pnömonitis, pulmoner hemoraji, sarkoid benzeri akciğer tutulumu, vaskülit, pulmoner tromboemboli; infeksiyöz yan etkiler- nötropeni (nadir),CMV koliti, Clostridium difficile’ e bağlı ishal, mikobakteriel infeksiyonlar; romatolojik yan etkiler- artrit, miyozit, polimiyaljia rheumatika; dermatolojik yan etkiler-vitiligo, liken, dermatomiyozit, Steven-Johnson sendromu; oküler yan etkile- üveit, optik sinir hastalıkları, koryoretinal lezyonlar.Hastaların yönetimi yakınmalarına ve muhtemel yan etkiye bağlı olarak değişmektedir ama daha çok kullanılan steroid tedavisidir. Hastaların yönetimi primer onkoloji doktorları ile konsülte edilerekyürütülmelidir
Anahtar Kelimeler
Kaynakça
- Bhardwaj M, Chiu MN, Pilkhwal Sah S. Adverse cutaneous toxicities by PD-1/PD-L1 immune checkpoint inhibitors: pathogenesis, treatment, and surveillance. Cutan Ocul Toxicol. 2022 Mar;41(1):73-90. doi: 10.1080/15569527.2022.2034842.
- Castillo RM, Sandefur BJ, Finch AS, Richter MD, Thanarajasingam U. Clinical Presentations and Outcomes of Patients Receiving Immune Checkpoint Inhibitors Presenting to the Emergency Department. Mayo Clin Proc Innov Qual Outcomes. 2021 Oct 30;5(6):1029-1035.
- Postow MA, Sidlow R, Hellmann MD. Immune-Related Adverse Events Associated with Immune Checkpoint Blockade. N Engl J Med. 2018 Jan 11;378(2):158-168.
- Waliany S, Neal JW, Reddy S, et al. Myocarditis Surveillance with HighSensitivity Troponin I During Cancer Treatment with Immune Checkpoint Inhibitors. JACC CardioOncol. 2021 Mar;3(1):137-139.
- Mahmood SS, Fradley MG, Cohen JV, et al. Myocarditis in Patients Treated With Immune Checkpoint Inhibitors. J Am Coll Cardiol. 2018 Apr 24;71(16):1755-1764.
- Dolladille C, Ederhy S, Allouche S, et al. Late cardiac adverse events in patients with cancer treated with immune checkpoint inhibitors. J Immunother Cancer. 2020 Jan;8(1):e000261.
- Baik AH, Oluwole OO, Johnson DB, et al. Mechanisms of Cardiovascular Toxicities Associated With Immunotherapies. Circ Res. 2021 May 28;128(11):1780-1801.
- Wei SC, Meijers WC, Axelrod ML, et al. A Genetic Mouse Model Recapitulates Immune Checkpoint Inhibitor-Associated Myocarditis and Supports a Mechanism-Based Therapeutic Intervention. Cancer Discov. 2021 Mar;11(3):614-625.
- Thuny F, Naidoo J, Neilan TG. Cardiovascular complications of immune checkpoint inhibitors for cancer. Eur Heart J. 2022 Nov 7;43(42):4458-4468. doi: 10.1093/eurheartj/ehac456.
- Suresh K, Naidoo J, Lin CT, Danoff S. Immune Checkpoint Immunotherapy for Non-Small Cell Lung Cancer: Benefits and Pulmonary Toxicities. Chest. 2018 Dec;154(6):1416-1423.
- Zhang Q, Tang L, Zhou Y, He W, Li W. Immune Checkpoint InhibitorAssociated Pneumonitis in Non-Small Cell Lung Cancer: Current Understanding in Characteristics, Diagnosis, and Management. Front Immunol. 2021 May 28;12:663986.
- Zhang ML, Neyaz A, Patil D, Chen J, Dougan M, Deshpande V. Immunerelated adverse events in the gastrointestinal tract: diagnostic utility of upper gastrointestinal biopsies. Histopathology. 2020 Jan;76(2):233-243.
- Garcia-Neuer M, Marmarelis ME, Jangi SR, Luke JJ, Ibrahim N, Davis M, Weinberg J, Donahue H, Bailey N, Hodi FS, Buchbinder EL, Ott PA. Diagnostic Comparison of CT Scans and Colonoscopy for ImmuneRelated Colitis in Ipilimumab-Treated Advanced Melanoma Patients. Cancer Immunol Res. 2017 Apr;5(4):286-291.
- Dougan M. Gastrointestinal and Hepatic Complications of Immunotherapy: Current Management and Future Perspectives. Curr Gastroenterol Rep. 2020 Mar 17;22(4):15.
- Ghosh N, Bass AR. Rheumatic Complications of Immune Checkpoint Inhibitors. Rheum Dis Clin North Am. 2022 May;48(2):411-428.
- Bhardwaj M, Chiu MN, Pilkhwal Sah S. Adverse cutaneous toxicities by PD-1/PD-L1 immune checkpoint inhibitors: pathogenesis, treatment, and surveillance. Cutan Ocul Toxicol. 2022 Mar;41(1):73-90.
- Iwama S, Kobayashi T, Yasuda Y, Arima H. Immune checkpoint inhibitorrelated thyroid dysfunction. Best Pract Res Clin Endocrinol Metab. 2022 May;36(3):101660.
- Higham CE, Olsson-Brown A, Carroll P, et al. Society for Endocrinology Endocrin Emergency Guidance: Acute management of the endocrine complications of checkpoint inhibitor therapy. Endocr Connect. 2018 Jul;7(7):G1-G7.
- Wladis EJ, Kambam ML. Ophthalmic complications of immune checkpoint inhibitors. Orbit. 2022 Feb;41(1):28-33
Öz
Immunotherapies have recently played an important role in the treatment of many types of cancer (such as non-small cell lung cancer, renal cell cancer, malignant melanoma, Hodgkin lymphoma). When immunocheckpoint inhibitors (IR) bind to their receptors, they prevent the signals that cause cells to overreact in the tumor tissue and limit the tissue damage that occurs during the inflammatory response process. Emergency Department visits of patients receiving this treatment also increase as the prevalence of the treatment increases. irAE covers a very broad spectrum. Cardiac side effects - myocarditis and related dysrhythmias, acute coronary syndrome, pericardial fluid and pericarditis; thoracic side effects - pneumonitis, pulmonary hemorrhage, sarcoid-like lung involvement, vasculitis, pulmonary thromboembolism; infectious side effects - neutropenia (rare), CMV colitis, diarrhea due to Clostridium difficile, mycobacterial infections; rheumatological side effects - arthritis, myositis, polymyalgia rheumatica; dermatological side effects-vitiligo, lichen, dermatomyositis, Steven-Johnson syndrome; Ocular side effects - uveitis, optic nerve diseases, chorioretinal lesions. Management of patients varies depending on their complaints and possible side effects, but the most used is steroid treatment. Management of patients should be carried out in consultation with primary oncology doctors.
Anahtar Kelimeler
Kaynakça
- Bhardwaj M, Chiu MN, Pilkhwal Sah S. Adverse cutaneous toxicities by PD-1/PD-L1 immune checkpoint inhibitors: pathogenesis, treatment, and surveillance. Cutan Ocul Toxicol. 2022 Mar;41(1):73-90. doi: 10.1080/15569527.2022.2034842.
- Castillo RM, Sandefur BJ, Finch AS, Richter MD, Thanarajasingam U. Clinical Presentations and Outcomes of Patients Receiving Immune Checkpoint Inhibitors Presenting to the Emergency Department. Mayo Clin Proc Innov Qual Outcomes. 2021 Oct 30;5(6):1029-1035.
- Postow MA, Sidlow R, Hellmann MD. Immune-Related Adverse Events Associated with Immune Checkpoint Blockade. N Engl J Med. 2018 Jan 11;378(2):158-168.
- Waliany S, Neal JW, Reddy S, et al. Myocarditis Surveillance with HighSensitivity Troponin I During Cancer Treatment with Immune Checkpoint Inhibitors. JACC CardioOncol. 2021 Mar;3(1):137-139.
- Mahmood SS, Fradley MG, Cohen JV, et al. Myocarditis in Patients Treated With Immune Checkpoint Inhibitors. J Am Coll Cardiol. 2018 Apr 24;71(16):1755-1764.
- Dolladille C, Ederhy S, Allouche S, et al. Late cardiac adverse events in patients with cancer treated with immune checkpoint inhibitors. J Immunother Cancer. 2020 Jan;8(1):e000261.
- Baik AH, Oluwole OO, Johnson DB, et al. Mechanisms of Cardiovascular Toxicities Associated With Immunotherapies. Circ Res. 2021 May 28;128(11):1780-1801.
- Wei SC, Meijers WC, Axelrod ML, et al. A Genetic Mouse Model Recapitulates Immune Checkpoint Inhibitor-Associated Myocarditis and Supports a Mechanism-Based Therapeutic Intervention. Cancer Discov. 2021 Mar;11(3):614-625.
- Thuny F, Naidoo J, Neilan TG. Cardiovascular complications of immune checkpoint inhibitors for cancer. Eur Heart J. 2022 Nov 7;43(42):4458-4468. doi: 10.1093/eurheartj/ehac456.
- Suresh K, Naidoo J, Lin CT, Danoff S. Immune Checkpoint Immunotherapy for Non-Small Cell Lung Cancer: Benefits and Pulmonary Toxicities. Chest. 2018 Dec;154(6):1416-1423.
- Zhang Q, Tang L, Zhou Y, He W, Li W. Immune Checkpoint InhibitorAssociated Pneumonitis in Non-Small Cell Lung Cancer: Current Understanding in Characteristics, Diagnosis, and Management. Front Immunol. 2021 May 28;12:663986.
- Zhang ML, Neyaz A, Patil D, Chen J, Dougan M, Deshpande V. Immunerelated adverse events in the gastrointestinal tract: diagnostic utility of upper gastrointestinal biopsies. Histopathology. 2020 Jan;76(2):233-243.
- Garcia-Neuer M, Marmarelis ME, Jangi SR, Luke JJ, Ibrahim N, Davis M, Weinberg J, Donahue H, Bailey N, Hodi FS, Buchbinder EL, Ott PA. Diagnostic Comparison of CT Scans and Colonoscopy for ImmuneRelated Colitis in Ipilimumab-Treated Advanced Melanoma Patients. Cancer Immunol Res. 2017 Apr;5(4):286-291.
- Dougan M. Gastrointestinal and Hepatic Complications of Immunotherapy: Current Management and Future Perspectives. Curr Gastroenterol Rep. 2020 Mar 17;22(4):15.
- Ghosh N, Bass AR. Rheumatic Complications of Immune Checkpoint Inhibitors. Rheum Dis Clin North Am. 2022 May;48(2):411-428.
- Bhardwaj M, Chiu MN, Pilkhwal Sah S. Adverse cutaneous toxicities by PD-1/PD-L1 immune checkpoint inhibitors: pathogenesis, treatment, and surveillance. Cutan Ocul Toxicol. 2022 Mar;41(1):73-90.
- Iwama S, Kobayashi T, Yasuda Y, Arima H. Immune checkpoint inhibitorrelated thyroid dysfunction. Best Pract Res Clin Endocrinol Metab. 2022 May;36(3):101660.
- Higham CE, Olsson-Brown A, Carroll P, et al. Society for Endocrinology Endocrin Emergency Guidance: Acute management of the endocrine complications of checkpoint inhibitor therapy. Endocr Connect. 2018 Jul;7(7):G1-G7.
- Wladis EJ, Kambam ML. Ophthalmic complications of immune checkpoint inhibitors. Orbit. 2022 Feb;41(1):28-33
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Acil Tıp |
| Bölüm | Derleme |
| Yazarlar | |
| Erken Görünüm Tarihi | 29 Aralık 2023 |
| Yayımlanma Tarihi | 29 Aralık 2023 |
| Gönderilme Tarihi | 19 Aralık 2023 |
| Kabul Tarihi | 25 Aralık 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 6 Sayı: 4 |
