内容紹介
Summary
Neuromuscular adverse events(AEs)associated with cancer treatment with immune checkpoint inhibitors(ICIs)include diverse clinical subsets. The general features of neuromuscular AEs have not been elucidated because the frequency is generally low, ranging from 1-2% of cancer patients undergoing ICIs therapy. The diseases affect the central nervous system, peripheral nerves, neuromuscular junction, and muscle. Disease onset and progression may be rapid with a critical clinical course. The clinical presentation may be different from that of patients unrelated to drugs. Headache, dizziness, and dysgeusia were relatively common and mild treatment-related AEs. In contrast, representative immune-related AEs such as autoimmune encephalitis, demyelinating polyneuropathy, myasthenia, and myositis were serious. There was a tight association between myasthenia, myositis, and myocarditis. There are guidelines for the treatment of neuromuscular immune-mediated AEs. For all but the minimum neurological symptoms, checkpoint inhibitor therapy should be withheld until the nature of the AEs is defined. Immune-modulating medication is generally effective for neuromuscular AEs. Both CD8+ cytotoxic T-cells and autoantibodies are involved in the pathogenesis of neuromuscular AEs. Correct understanding of neuromuscular AEs is required for the best management of cancer patients.
要旨
がん免疫治療の中心である免疫チェックポイント阻害剤の治療中に発症する神経・筋障害の有害事象の頻度は低いものの,多彩な疾患が含まれる。現在,確実な免疫関連有害事象として考えられている代表的な疾患が,自己免疫性脳炎,脱髄性ニューロパチー,重症筋無力症,筋炎である。薬剤との因果関係が明らかでない場合や,免疫学的機序の関与が考えにくい疾患も発症する可能性がある。重症例が多いものの免疫抑制治療は有効であり,迅速かつ適切な対応が必要である。
目次
Neuromuscular adverse events(AEs)associated with cancer treatment with immune checkpoint inhibitors(ICIs)include diverse clinical subsets. The general features of neuromuscular AEs have not been elucidated because the frequency is generally low, ranging from 1-2% of cancer patients undergoing ICIs therapy. The diseases affect the central nervous system, peripheral nerves, neuromuscular junction, and muscle. Disease onset and progression may be rapid with a critical clinical course. The clinical presentation may be different from that of patients unrelated to drugs. Headache, dizziness, and dysgeusia were relatively common and mild treatment-related AEs. In contrast, representative immune-related AEs such as autoimmune encephalitis, demyelinating polyneuropathy, myasthenia, and myositis were serious. There was a tight association between myasthenia, myositis, and myocarditis. There are guidelines for the treatment of neuromuscular immune-mediated AEs. For all but the minimum neurological symptoms, checkpoint inhibitor therapy should be withheld until the nature of the AEs is defined. Immune-modulating medication is generally effective for neuromuscular AEs. Both CD8+ cytotoxic T-cells and autoantibodies are involved in the pathogenesis of neuromuscular AEs. Correct understanding of neuromuscular AEs is required for the best management of cancer patients.
要旨
がん免疫治療の中心である免疫チェックポイント阻害剤の治療中に発症する神経・筋障害の有害事象の頻度は低いものの,多彩な疾患が含まれる。現在,確実な免疫関連有害事象として考えられている代表的な疾患が,自己免疫性脳炎,脱髄性ニューロパチー,重症筋無力症,筋炎である。薬剤との因果関係が明らかでない場合や,免疫学的機序の関与が考えにくい疾患も発症する可能性がある。重症例が多いものの免疫抑制治療は有効であり,迅速かつ適切な対応が必要である。