内容紹介
Summary
The frequency of respiratory infections as an infection in cancer patients is high. Several factors increase the risk of respiratory infections in cancer patients. These include airway obstruction, disruption of mucosal surfaces and treatment-related factors, such as radiation and chemotherapy. It has also been reported that the frequency and mortality of drug-induced lung injury associated with antineoplastic drugs are high in Japan. In the diagnosis and treatment of drug-induced lung disease, it is important to distinguish pneumonia as an infectious disorder. Immune checkpoint inhibitors(ICIs)have been widely introduced to treat several types of malignancies. It is currently believed that ICIs do not increase the risk of infections. However, immune-related adverse events(irAEs)induced by ICIs may necessitate the administration of immunosuppressive agents, which could cause opportunistic infections. Furthermore, several reports describe reactivation tuberculosis without irAEs or immunosuppressants. Further studies are needed to prevent the development of tuberculosis in patients receiving ICIs.
要旨
癌患者での感染症としての肺炎・呼吸器感染症の頻度は高い。呼吸器の腫瘍の存在そのものが気道閉塞,粘膜障害をもたらし,感染症が引き起こされる。さらに放射線化学療法に伴い呼吸器における感染防御能が低下し,種々の呼吸器感染症が惹起されることも知られている。また,わが国での抗悪性腫瘍薬に伴う薬剤性肺障害の発症頻度と死亡率は高いとされ,その診断,治療においては感染症としての肺炎との鑑別が重要である。免疫チェックポイント阻害薬(immune checkpoint inhibitors: ICIs)が種々の癌の治療に導入されている。ICIs治療に伴い感染症のリスクが大幅に増すとは考えられていないが,免疫関連有害事象(immune-related adverse events: irAEs)発生時には免疫抑制剤投与を要することから日和見感染が起こり得る。さらにirAEsを伴わず免疫抑制剤も投与されていない場合での結核の報告もあり,感染予防も含めて今後の対策が求められる。
目次
The frequency of respiratory infections as an infection in cancer patients is high. Several factors increase the risk of respiratory infections in cancer patients. These include airway obstruction, disruption of mucosal surfaces and treatment-related factors, such as radiation and chemotherapy. It has also been reported that the frequency and mortality of drug-induced lung injury associated with antineoplastic drugs are high in Japan. In the diagnosis and treatment of drug-induced lung disease, it is important to distinguish pneumonia as an infectious disorder. Immune checkpoint inhibitors(ICIs)have been widely introduced to treat several types of malignancies. It is currently believed that ICIs do not increase the risk of infections. However, immune-related adverse events(irAEs)induced by ICIs may necessitate the administration of immunosuppressive agents, which could cause opportunistic infections. Furthermore, several reports describe reactivation tuberculosis without irAEs or immunosuppressants. Further studies are needed to prevent the development of tuberculosis in patients receiving ICIs.
要旨
癌患者での感染症としての肺炎・呼吸器感染症の頻度は高い。呼吸器の腫瘍の存在そのものが気道閉塞,粘膜障害をもたらし,感染症が引き起こされる。さらに放射線化学療法に伴い呼吸器における感染防御能が低下し,種々の呼吸器感染症が惹起されることも知られている。また,わが国での抗悪性腫瘍薬に伴う薬剤性肺障害の発症頻度と死亡率は高いとされ,その診断,治療においては感染症としての肺炎との鑑別が重要である。免疫チェックポイント阻害薬(immune checkpoint inhibitors: ICIs)が種々の癌の治療に導入されている。ICIs治療に伴い感染症のリスクが大幅に増すとは考えられていないが,免疫関連有害事象(immune-related adverse events: irAEs)発生時には免疫抑制剤投与を要することから日和見感染が起こり得る。さらにirAEsを伴わず免疫抑制剤も投与されていない場合での結核の報告もあり,感染予防も含めて今後の対策が求められる。