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몇몇 암세포들은 T cell이 자신들을 죽이는 것을 막기 위해 surface protein을 만들어 냄.
Immune checkpoint inhibitor therapy는 암세포와 T-cell에 모두 붙는 monoclonal antibodies를
통하여 surface protein을 무효화시켜 암세포를 죽이게 만드는 치료법.
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Ipilimumba, Nivolumab, Pembrolizumab
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Immune checkpoint inhibitor induced immune related adverse effect
→ 사용에 따른 Potential immune-mediated cause로 인해 발생하는 모든 부작용
(1) 증상
1 Diarrhea
5 Pneumonitis
9 Vasculitis
2 Enterocolitis
6 Dermatitis
10 Anemia
3 Hypophysititis
7 Adrenalitis
11 Uveitis
4 Pancreatitis
8 Nephritis
(2) 치료
1 Mild toxicities → Oral antipruritics
2 Severe toxicities → systemic glucocorticoids
ØEpidemiology
üImmune-related adverse events (irAEs) occur in 60-80% of patients receiving ICIs.
üSevere (grade ≥3) irAEs in 10-20%, usually within 6-12 weeks of therapy.
üMore frequent with combination therapy
(ex. Nivolumab + ipilimumab)
üCommon organs involved:
skin, colon, liver, lung, endocrine glands.
ØManagement
üGrade 1 (Mild): Continue ICI + close monitoring
üGrade 2 (Moderate): Hold ICI, start prednisone 0.5-1 mg/kg/day
üGrade ≥3 (Severe): Permanently discontinue ICI, start high dose IV steroids (Methylpred 1-2mg/kg/day)
üSteroid-refractory cased: Add inifliximab, mycophenolate, IVIG, or tocilizumab (organ-specific)
üEndocrine irAEs: Replace hormones (thyroxine, insulin, hydrocortisone)
üPneumonitis: High dose steroids
üMonitor liver, renal, thyroid, and glucose periodically during therapy
