-
Categories
-
Pharmaceutical Intermediates
-
Active Pharmaceutical Ingredients
-
Food Additives
- Industrial Coatings
- Agrochemicals
- Dyes and Pigments
- Surfactant
- Flavors and Fragrances
- Chemical Reagents
- Catalyst and Auxiliary
- Natural Products
- Inorganic Chemistry
-
Organic Chemistry
-
Biochemical Engineering
- Analytical Chemistry
-
Cosmetic Ingredient
- Water Treatment Chemical
-
Pharmaceutical Intermediates
Promotion
ECHEMI Mall
Wholesale
Weekly Price
Exhibition
News
-
Trade Service
*Only for medical professionals to read and refer to the problem of adverse reactions to immunotherapy
.
Lung cancer is the cancer with the highest incidence and mortality in China
.
Data show that in 2020, about 37% of new lung cancer cases worldwide will come from China; and 39.
8% of global lung cancer deaths will come from China
.
The latest clinical studies show that immunotherapy can bring more survival benefits to patients with early stage lung cancer and operable locally advanced lung cancer patients
.
Immune checkpoint inhibitors (ICI) have become one of the most important first-line and second-line treatment strategies for advanced non-small cell lung cancer (NSCLC)
.
Immunotherapy is like "relaxing" the immune system so that it can better attack cancer cells, but it also increases the risk of the immune system attacking normal tissues and may cause adverse immunotherapy (irAE)
.
The Medical Oncology Channel sincerely invites Professor Nie Wei from the Chest Hospital of Shanghai Jiaotong University to share his views on the monitoring and management of lung cancer irAE, and to convey the voice of academics
.
irAE is "out of sight", evaluation and monitoring are indispensable.
The clinical diagnosis and treatment of lung cancer is still severe.
The 5-year survival rate of advanced lung cancer is only about 5%
.
With the advent of immunotherapy, the 5-year survival rate of advanced lung cancer has greatly increased, reaching about 15%
.
While immunotherapy provides the possibility of long-term survival for patients with advanced lung cancer, it also brings about the problem of adverse effects of immunotherapy
.
Professor Nie Wei pointed out: From the point of view of the location, irAE may occur in various organs and tissues after systemic treatment, including the head, nervous system, eyes, thyroid, heart, lung, liver, digestive tract, kidney, pancreas, skin, mucosa and skeletal muscle and other tissues
.
Most of these adverse reactions are relatively mild and can be relieved after proper treatment and treatment.
From the time of occurrence, irAE may occur at any time after treatment, usually within a few weeks to several months after the initial treatment
.
It is worth noting that for patients receiving combined immunotherapy, such as PD-1 combined with CTLA-4, the patient's adverse reactions to immunotherapy may occur earlier and the symptoms may worsen
.
This also reminds clinicians that they should do a baseline assessment when giving patients immunotherapy
.
During the treatment process, timely and meticulous monitoring, including patient symptoms, signs, hematological indicators and imaging changes, can be used to identify and predict the occurrence of severe irAE as soon as possible, so as to improve the patient's prognosis
.
Are there differences in the occurrence of irAE among different ICIs? At present, clinically commonly used immune ICIs mainly include PD-1 inhibitors, PD-L1 inhibitors, and CTLA-4 inhibitors.
The occurrence and severity of irAE are different
.
When talking about the incidence and severity of irAE, Professor Nie Wei said: “Previous studies have shown that the incidence of CTLA-4 inhibitor irAE is higher, reaching 75% (24% to 43% of which are above grade 3), PD-1 Inhibitors and PD-L1 inhibitors have a relatively low incidence of irAE
.
For example, the most common irAE of CTLA-4 antibody ipilimumab is skin and gastrointestinal toxicity
.
The common irAE of
PD-1 antibody pembrolizumab It is skin, lung and thyroid toxicity; another major irAE of PD-1 antibody nivolumab is endocrine toxicity
.
Among PD-L1 antibodies, the most common irAE of atelizumab and duvalizumab is endocrine toxicity
.
"Understanding and familiarizing with the irAE spectrum can help clinicians inform patients and family members of irAE events and the possibility of occurrence in time, and assist patients in monitoring the occurrence of irAE after discharge from the hospital, and timely feedback abnormal manifestations to the treating doctors to minimize seriousness.
The occurrence
of
irAE .
How to deal with irAE? From the perspective of treatment mode, immunotherapy has evolved from the previous single-agent treatment mode to the existing combination treatment mode, including the combination with chemotherapy, anti-angiogenic drugs, radiotherapy and other ICIs
.
At the same time, irAE also brought to clinical work a great challenge
.
how to deal with irAE Professor Nie Wei said:? "first of all should be emphasized that to prevent and reduce the occurrence of adverse reactions, which requires clinicians and patients to establish good Communication relationship
.
Before treatment, clinicians should explain the immunotherapy risks and common adverse reactions to patients and their families in detail, and remind patients to monitor themselves after discharge.
If abnormalities occur, they should communicate with clinicians in time and take corresponding measures
.
"In addition, the work of clinicians before immunotherapy plays an important role
.
Professor Nie Wei analyzed: "The patient's medical history should be recorded before treatment, including autoimmune diseases, infectious diseases, and organ-specific diseases
.
Baseline assessments such as hematology and cardiac function cannot be ignored either.
Immunotherapy can only be initiated on the premise of ensuring safety
.
Before starting the next immunotherapy, it is also necessary to evaluate the corresponding baseline indicators
.
During this process, some patients may have subclinical organ damage but no clinical symptoms.
At this time, if the patient is given immunotherapy, the patient may progress to a serious adverse event
.
"What are the considerations for choosing immunotherapy drugs? Professor Nie Wei emphasized: "We should choose drugs with less toxic and side effects within the scope of indications
.
It is worth mentioning that even if the patient has an irAE, there is no need to worry too much
.
The diagnosis and classification of irAE can be determined based on the patient's symptoms, signs, and laboratory tests .
Based on high-level evidence-based medical evidence, treatment measures such as drug withdrawal, hormone therapy or multidisciplinary diagnosis and treatment (MDT) are given to patients
.
After standard treatment, most irAE can be alleviated
.
"Can immunotherapy be restarted? Some lung cancer patients may stop taking the drug due to severe irAE.
The issue of immune restart caused by this has attracted widespread attention from clinicians and patients
.
First, we need to consider whether we should restart the immune system
.
Professor Nie Wei talked about it.
Said: "According to relevant domestic and foreign guidelines, it is recommended: Level 1 irAE does not affect the continued use of immunotherapy; Level 2 irAE can restart immunotherapy after the disease is relieved; Whether to restart immunotherapy after level 3 irAE occurs, it should be carefully considered; Level 4 irAE It is not recommended to restart immunotherapy after the occurrence
.
What needs attention is that for some highly fatal irAEs, such as immunotherapy-related myocarditis, even if it is level II, it is not recommended to restart immunotherapy
.
Relevant studies have shown that after immune-related neurological symptoms appear, the restart of immunotherapy requires careful judgment
.
In general, restarting immunotherapy is based on the principle that the benefits outweigh the risks.
Before restarting, you should fully communicate with patients and their families to gain understanding
.
When necessary, adopt the MDT mode to develop a complete treatment plan
.
"Secondly, regarding the timing of immune restart, Professor Nie Wei said: "Before the occurrence of grade 3 irAE, the tumor has reached an objective state of remission, so immunotherapy does not need to be restarted immediately.
.
At this time, there may be long-term immune memory in the patient's body, which has an inhibitory effect on tumors
.
When the tumor progresses, consider restarting the immune system
.
Before the occurrence of tertiary irAE, the tumor did not respond sufficiently or did not respond.
At this time, immune restart can be considered
.
At the same time of restarting, careful and complete monitoring is also required to avoid the occurrence of serious adverse events
.
"What are the precautions after immune restart? Professor Nie Wei pointed out: "Immunotherapy restart may consider replacing other immunotherapy drugs
.
In the field of lung cancer, there is no high-level evidence-based medical evidence to support that immune restart can bring long-term benefits to patients
.
Some small sample studies suggest that immune restart can bring survival benefits to some lung cancer patients, but this benefit is also accompanied by high risks
.
Existing data show that about 30% to 50% of patients may have irAE again after immune restart, and about 10% of patients may have immune-related deaths after immune restart
.
"Immunotherapy has expanded from NSCLC to small cell lung cancer (SCLC).
It is also moving from advanced treatment to postoperative adjuvant therapy and preoperative neoadjuvant therapy, from posterior line therapy to first-line therapy, and the treatment population is even from driving genes.
Negative patients have gradually expanded to drive gene-positive patients
.
With the widespread use of ICIs, the occurrence of irAE will involve more people, and serious adverse reactions may cause treatment interruption or even threaten the lives of patients.
Therefore, we must attach great importance to standard treatment
.
Expert profile Professor Nie Wei, deputy chief physician, doctor of medicine, and postdoctoral fellow of the Department of Respiratory Medicine, Chest Hospital Affiliated to Shanghai Jiaotong University One person in charge undertakes a National Natural Science Foundation of China's "Chinese Expert Consensus on the Application of Tumor Mutation Burden to Lung Cancer Immunotherapy" and the first and corresponding author published SCI in JNCCN, Intensive Care Medicine, BMC Medicine, Cancer Letters, OncoImmunoloy and other journals More than 40 references in the paper: [1] BertrandA, KostineM, BarnetcheT, et al.
Immune related adverse events associated with anti-CTLA-4 antibodies: systematic review and meta-analysis[J].
BMC Med, 2015, 13:211 .
DOI: 10.
1186/s12916-015-0455-8.
[2] "Guidelines for the Management of Toxicity Related to CSCO Immune Checkpoint Inhibitors" version 2021
.
Lung cancer is the cancer with the highest incidence and mortality in China
.
Data show that in 2020, about 37% of new lung cancer cases worldwide will come from China; and 39.
8% of global lung cancer deaths will come from China
.
The latest clinical studies show that immunotherapy can bring more survival benefits to patients with early stage lung cancer and operable locally advanced lung cancer patients
.
Immune checkpoint inhibitors (ICI) have become one of the most important first-line and second-line treatment strategies for advanced non-small cell lung cancer (NSCLC)
.
Immunotherapy is like "relaxing" the immune system so that it can better attack cancer cells, but it also increases the risk of the immune system attacking normal tissues and may cause adverse immunotherapy (irAE)
.
The Medical Oncology Channel sincerely invites Professor Nie Wei from the Chest Hospital of Shanghai Jiaotong University to share his views on the monitoring and management of lung cancer irAE, and to convey the voice of academics
.
irAE is "out of sight", evaluation and monitoring are indispensable.
The clinical diagnosis and treatment of lung cancer is still severe.
The 5-year survival rate of advanced lung cancer is only about 5%
.
With the advent of immunotherapy, the 5-year survival rate of advanced lung cancer has greatly increased, reaching about 15%
.
While immunotherapy provides the possibility of long-term survival for patients with advanced lung cancer, it also brings about the problem of adverse effects of immunotherapy
.
Professor Nie Wei pointed out: From the point of view of the location, irAE may occur in various organs and tissues after systemic treatment, including the head, nervous system, eyes, thyroid, heart, lung, liver, digestive tract, kidney, pancreas, skin, mucosa and skeletal muscle and other tissues
.
Most of these adverse reactions are relatively mild and can be relieved after proper treatment and treatment.
From the time of occurrence, irAE may occur at any time after treatment, usually within a few weeks to several months after the initial treatment
.
It is worth noting that for patients receiving combined immunotherapy, such as PD-1 combined with CTLA-4, the patient's adverse reactions to immunotherapy may occur earlier and the symptoms may worsen
.
This also reminds clinicians that they should do a baseline assessment when giving patients immunotherapy
.
During the treatment process, timely and meticulous monitoring, including patient symptoms, signs, hematological indicators and imaging changes, can be used to identify and predict the occurrence of severe irAE as soon as possible, so as to improve the patient's prognosis
.
Are there differences in the occurrence of irAE among different ICIs? At present, clinically commonly used immune ICIs mainly include PD-1 inhibitors, PD-L1 inhibitors, and CTLA-4 inhibitors.
The occurrence and severity of irAE are different
.
When talking about the incidence and severity of irAE, Professor Nie Wei said: “Previous studies have shown that the incidence of CTLA-4 inhibitor irAE is higher, reaching 75% (24% to 43% of which are above grade 3), PD-1 Inhibitors and PD-L1 inhibitors have a relatively low incidence of irAE
.
For example, the most common irAE of CTLA-4 antibody ipilimumab is skin and gastrointestinal toxicity
.
The common irAE of
PD-1 antibody pembrolizumab It is skin, lung and thyroid toxicity; another major irAE of PD-1 antibody nivolumab is endocrine toxicity
.
Among PD-L1 antibodies, the most common irAE of atelizumab and duvalizumab is endocrine toxicity
.
"Understanding and familiarizing with the irAE spectrum can help clinicians inform patients and family members of irAE events and the possibility of occurrence in time, and assist patients in monitoring the occurrence of irAE after discharge from the hospital, and timely feedback abnormal manifestations to the treating doctors to minimize seriousness.
The occurrence
of
irAE .
How to deal with irAE? From the perspective of treatment mode, immunotherapy has evolved from the previous single-agent treatment mode to the existing combination treatment mode, including the combination with chemotherapy, anti-angiogenic drugs, radiotherapy and other ICIs
.
At the same time, irAE also brought to clinical work a great challenge
.
how to deal with irAE Professor Nie Wei said:? "first of all should be emphasized that to prevent and reduce the occurrence of adverse reactions, which requires clinicians and patients to establish good Communication relationship
.
Before treatment, clinicians should explain the immunotherapy risks and common adverse reactions to patients and their families in detail, and remind patients to monitor themselves after discharge.
If abnormalities occur, they should communicate with clinicians in time and take corresponding measures
.
"In addition, the work of clinicians before immunotherapy plays an important role
.
Professor Nie Wei analyzed: "The patient's medical history should be recorded before treatment, including autoimmune diseases, infectious diseases, and organ-specific diseases
.
Baseline assessments such as hematology and cardiac function cannot be ignored either.
Immunotherapy can only be initiated on the premise of ensuring safety
.
Before starting the next immunotherapy, it is also necessary to evaluate the corresponding baseline indicators
.
During this process, some patients may have subclinical organ damage but no clinical symptoms.
At this time, if the patient is given immunotherapy, the patient may progress to a serious adverse event
.
"What are the considerations for choosing immunotherapy drugs? Professor Nie Wei emphasized: "We should choose drugs with less toxic and side effects within the scope of indications
.
It is worth mentioning that even if the patient has an irAE, there is no need to worry too much
.
The diagnosis and classification of irAE can be determined based on the patient's symptoms, signs, and laboratory tests .
Based on high-level evidence-based medical evidence, treatment measures such as drug withdrawal, hormone therapy or multidisciplinary diagnosis and treatment (MDT) are given to patients
.
After standard treatment, most irAE can be alleviated
.
"Can immunotherapy be restarted? Some lung cancer patients may stop taking the drug due to severe irAE.
The issue of immune restart caused by this has attracted widespread attention from clinicians and patients
.
First, we need to consider whether we should restart the immune system
.
Professor Nie Wei talked about it.
Said: "According to relevant domestic and foreign guidelines, it is recommended: Level 1 irAE does not affect the continued use of immunotherapy; Level 2 irAE can restart immunotherapy after the disease is relieved; Whether to restart immunotherapy after level 3 irAE occurs, it should be carefully considered; Level 4 irAE It is not recommended to restart immunotherapy after the occurrence
.
What needs attention is that for some highly fatal irAEs, such as immunotherapy-related myocarditis, even if it is level II, it is not recommended to restart immunotherapy
.
Relevant studies have shown that after immune-related neurological symptoms appear, the restart of immunotherapy requires careful judgment
.
In general, restarting immunotherapy is based on the principle that the benefits outweigh the risks.
Before restarting, you should fully communicate with patients and their families to gain understanding
.
When necessary, adopt the MDT mode to develop a complete treatment plan
.
"Secondly, regarding the timing of immune restart, Professor Nie Wei said: "Before the occurrence of grade 3 irAE, the tumor has reached an objective state of remission, so immunotherapy does not need to be restarted immediately.
.
At this time, there may be long-term immune memory in the patient's body, which has an inhibitory effect on tumors
.
When the tumor progresses, consider restarting the immune system
.
Before the occurrence of tertiary irAE, the tumor did not respond sufficiently or did not respond.
At this time, immune restart can be considered
.
At the same time of restarting, careful and complete monitoring is also required to avoid the occurrence of serious adverse events
.
"What are the precautions after immune restart? Professor Nie Wei pointed out: "Immunotherapy restart may consider replacing other immunotherapy drugs
.
In the field of lung cancer, there is no high-level evidence-based medical evidence to support that immune restart can bring long-term benefits to patients
.
Some small sample studies suggest that immune restart can bring survival benefits to some lung cancer patients, but this benefit is also accompanied by high risks
.
Existing data show that about 30% to 50% of patients may have irAE again after immune restart, and about 10% of patients may have immune-related deaths after immune restart
.
"Immunotherapy has expanded from NSCLC to small cell lung cancer (SCLC).
It is also moving from advanced treatment to postoperative adjuvant therapy and preoperative neoadjuvant therapy, from posterior line therapy to first-line therapy, and the treatment population is even from driving genes.
Negative patients have gradually expanded to drive gene-positive patients
.
With the widespread use of ICIs, the occurrence of irAE will involve more people, and serious adverse reactions may cause treatment interruption or even threaten the lives of patients.
Therefore, we must attach great importance to standard treatment
.
Expert profile Professor Nie Wei, deputy chief physician, doctor of medicine, and postdoctoral fellow of the Department of Respiratory Medicine, Chest Hospital Affiliated to Shanghai Jiaotong University One person in charge undertakes a National Natural Science Foundation of China's "Chinese Expert Consensus on the Application of Tumor Mutation Burden to Lung Cancer Immunotherapy" and the first and corresponding author published SCI in JNCCN, Intensive Care Medicine, BMC Medicine, Cancer Letters, OncoImmunoloy and other journals More than 40 references in the paper: [1] BertrandA, KostineM, BarnetcheT, et al.
Immune related adverse events associated with anti-CTLA-4 antibodies: systematic review and meta-analysis[J].
BMC Med, 2015, 13:211 .
DOI: 10.
1186/s12916-015-0455-8.
[2] "Guidelines for the Management of Toxicity Related to CSCO Immune Checkpoint Inhibitors" version 2021
