i Hope College. Professor Qin Haifeng: Can patients who stop taking drugs due to adverse reactions challenge immunotherapy again?

Professor Qin Haifeng: can we still challenge the treatment of adverse reactions? Qin Haifeng Professor: deputy chief physician and associate professor of pulmonary oncology department of cancer center of the fifth medical center of PLA General Hospital; chairman of respiratory cancer adverse drug reaction management committee of Beijing Cancer Prevention and control society; Deputy Secretary General of precision medicine and Tumor Rehabilitation Professional Committee of China Association for promotion of rehabilitation technology transformation and development; standing committee member of psychosomatic Professional Committee of Chinese Medicine Association of the whole army The appearance of immunosuppressant has rewritten the history of cancer treatment and made it possible to realize the beautiful vision of "tumor becoming chronic disease".with the popularization of immunotherapy, immune related adverse events have become increasingly prominent. The mechanism of immunosuppressive checkpoint inhibitors is different from that of chemotherapy and targeted therapy, resulting in different spectrum of adverse reactions. The adverse reactions related to immunotherapy may involve multiple systems, which can occur in various processes of immunotherapy, and some are even fatal.today, we will talk about the patients who stop taking drugs due to adverse reactions, can they challenge immunotherapy again? The largest retrospective analysis to date extracted 24079 Irae cases from vigibase database from 2016 to September 1, 2019.through the analysis, the cancer with high frequency of re challenge by immunotherapy includes head and neck cancer, renal cancer and urinary system tumor, while patients with gynecological tumor, lung cancer and prostate cancer are less likely to receive immunotherapy re challenge.after challenge, the recurrence rate of colitis, hepatitis and pneumonia was higher, while the recurrence rate of adrenal iraes was lower than that of other iraes.iraes associated with high mortality include myocarditis and neurogenic iraes.among the patients who stopped ICI treatment after the first occurrence of Irae and subsequently challenged the same ICI treatment again, about 1 / 4 to 1 / 3 of the patients relapsed with the same Irae; 4.4% of the patients had different iraes.the recurrence rate of Irae varies with the type of Irae and the treatment plan of ICI.the spectrum of side effects and the risk of recurrence were different among different ICIS treatment schemes. After combined treatment, the recurrence of pneumonia was the most frequent (85.7%).2020.v1 NCCN guidelines mentioned the general principles of immunotherapy re challenge: 1. In case of severe Irae, re use of immunotherapy should be cautious and closely monitor the recurrence of Irae in related organs.if Irae occurs again, the drug should be stopped permanently; 2. The tumor status of the patient should be evaluated before using again. If the treatment of the inhibitor at the first immune checkpoint has been relieved (completely or partially), considering the risk of toxicity recurrence, it is not recommended to resume immunotherapy; 3 For severe Irae caused by immunotherapy, the same type of immunotherapy should be stopped permanently, and moderate Irae should also be cautious; if patients with grade 3 / 4 Irae caused by ipilimumab treatment, they can consider using PD-1 / PD-L1 inhibitor monotherapy after recovery; 4. Except for some special cases, when the toxicity of grade 2 Irae is less than or equal to grade 1, the immunotherapy can be started again.because of Irae, it is recommended to start treatment again after consulting relevant organ disease experts.and fully communicate with patients about the risk benefit ratio of receiving immunotherapy again.to sum up, each patient who needs to challenge immunotherapy again should be carefully discussed and decided according to the individual situation of each patient. In this case, multidisciplinary discussion is very valuable.the indications of immunosuppressants are expanding, and the dosage and treatment plan are also constantly updated. It is expected that we can go further on the road of efficient detoxification in the future.