内容紹介
Summary
With the advent of immune checkpoint inhibitors(ICIs), the standard treatment for advanced cancer is changing significantly. While ICI is expected to be more effective than conventional treatments, immune-related adverse events(irAEs)such as autoimmune diseases and inflammatory diseases may occur. Therefore, the management different from the side effects of conventional cytotoxic chemotherapy is necessary. Although many of the liver dysfunctions due to irAE are of low grade, cases of Grade 3 or higher have been reported. The point of management for irAE is early appropriate treatment according to early diagnosis and management algorithm. In the treatment of liver dysfunction due to irAE, corticosteroids are used as the first-line drug, and other immunosuppressive agents are examined when the effects of steroids are insufficient. Liver dysfunction caused by irAE can lead to fatal or irreversible damage if delayed and severe, but there are many things that can be managed if diagnosed early and given appropriate treatment. In the future, with the expansion of applicable cancer types and the introduction of combination therapy with different ICI combinations and molecular target drugs, specialists in digestive organs or liver will join the ICI treatment team to conduct appropriate liver dysfunction management at an early stage. It is thought that it will become more and more important.
要旨
免疫チェックポイント阻害薬(immune checkpoint inhibitor: ICI)には高い有効性が期待される一方,自己免疫疾患や炎症性疾患様の免疫関連有害事象(immune-related adverse event: irAE)が発現することがあり,適切なマネージメントが必要である。irAEによる肝機能障害に対するマネージメントのポイントは,早期診断とマネージメントアルゴリズムに従った早期の適切な治療であり,これらができればコントロール可能なことが多いと考えられる。一方,対応が遅れて重症化すると致死的になる場合や,不可逆的な障害につながる場合があることを臨床医は心得ておく必要がある。特に慢性肝疾患を合併した症例におけるirAEによる肝機能障害の予後に関しては未だ十分なデータがなく,慎重な対応が必要である。ICIによるがん治療を行う医療機関においては,肝臓専門医もしくは消化器病専門医がICI治療のチームにかかわり,早期に適切な肝機能障害の診断と治療ができる体制を構築することが重要である。
目次
With the advent of immune checkpoint inhibitors(ICIs), the standard treatment for advanced cancer is changing significantly. While ICI is expected to be more effective than conventional treatments, immune-related adverse events(irAEs)such as autoimmune diseases and inflammatory diseases may occur. Therefore, the management different from the side effects of conventional cytotoxic chemotherapy is necessary. Although many of the liver dysfunctions due to irAE are of low grade, cases of Grade 3 or higher have been reported. The point of management for irAE is early appropriate treatment according to early diagnosis and management algorithm. In the treatment of liver dysfunction due to irAE, corticosteroids are used as the first-line drug, and other immunosuppressive agents are examined when the effects of steroids are insufficient. Liver dysfunction caused by irAE can lead to fatal or irreversible damage if delayed and severe, but there are many things that can be managed if diagnosed early and given appropriate treatment. In the future, with the expansion of applicable cancer types and the introduction of combination therapy with different ICI combinations and molecular target drugs, specialists in digestive organs or liver will join the ICI treatment team to conduct appropriate liver dysfunction management at an early stage. It is thought that it will become more and more important.
要旨
免疫チェックポイント阻害薬(immune checkpoint inhibitor: ICI)には高い有効性が期待される一方,自己免疫疾患や炎症性疾患様の免疫関連有害事象(immune-related adverse event: irAE)が発現することがあり,適切なマネージメントが必要である。irAEによる肝機能障害に対するマネージメントのポイントは,早期診断とマネージメントアルゴリズムに従った早期の適切な治療であり,これらができればコントロール可能なことが多いと考えられる。一方,対応が遅れて重症化すると致死的になる場合や,不可逆的な障害につながる場合があることを臨床医は心得ておく必要がある。特に慢性肝疾患を合併した症例におけるirAEによる肝機能障害の予後に関しては未だ十分なデータがなく,慎重な対応が必要である。ICIによるがん治療を行う医療機関においては,肝臓専門医もしくは消化器病専門医がICI治療のチームにかかわり,早期に適切な肝機能障害の診断と治療ができる体制を構築することが重要である。