Imunotherapy : new drugs, different adverse events

Imunoterapija je v zadnjih letih postala eden izmed pomembnih načinov sistemskega zdravljenja bolnikov z rakom. Priča smo bili različnim imunskim strategijam, med temi je tudi inhibicija kontrolnih točk. Zdravila proti CTLA-4, PD-1 in PD-L1 so protitelesa proti zaviralcem kontrolnih točk, ki lahko povišajo imunsko aktivnost proti rakavim celicam in tako ojačajo imunski odgovor proti raku. Večja uporaba teh zdravil pa je privedla do pojava posebne vrste imunsko pogojenih neželenih učinkov. Ti se najpogosteje izrazijo na koži, črevesju, žlezah z notranjim izločanjem, pljučih in mišično-skeletnem sistemu, lahko pa je prizadet kateri koli organ. Večina imunsko pogojenih neželenih učinkov je blagih do zmernih, v literaturi pa obstajajo poročila o hudih in življenje ogrožajočih. Pomembna je njihova zgodnja prepoznava in zdravljenje, kakor tudi multidisciplinaren pristop, da preprečimo resne zaplete.Over the past years, immunotherapy has become an important systemic treatment strategy for cancer patients. We have seen multiple different strategies, and checkpoint blockade is one them. Anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed cell death-1 (PD-1), and programmed death-ligand 1 (PD-L1) are antibodies against checkpoint inhibitors that can increase immune activity against cancer, thus making the immune system stronger against cancer cells. However, the increasing use of these agents has exposed a discrete group of immune-related adverse events (irAEs). Skin, gut, endocrine, lung, and musculoskeletal irAEs are the most common, although every organ can be affected. The majority of irAEs are mild to moderate in severity, however, serious and life-threatening irAEs are reported in literature. Early detection and treatment of irAEs is important, and a multidisciplinary approach is sometimes needed to prevent serious consequences

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