Nebenwirkungen immunonkologischer Therapien

Zusammenfassung

Immunonkologische Therapien und insbesondere die Immuncheckpoint-Inhibitoren (ICPi) als Hauptvertreter dieser neuen Substanzklasse kommen bei zunehmender Anzahl von soliden und teils auch hämatologischen Tumorentitäten und Indikationen zum Einsatz. Die relativ hohen (Langzeit-)Tumoransprechraten auch in fortgeschrittenen und therapierefraktären Stadien haben die therapeutischen Möglichkeiten der Onkologie geradezu revolutioniert. Gleichzeitig bringt der zunehmende Einsatz von ICPi auch neue Herausforderungen: Immunonkologische Therapien verursachen ein breites Spektrum an autoimmunen Nebenwirkungen, sogenannten „immune-related adverse events“ (irAEs), die teilweise klassischen Autoimmunopathien ähneln und jedes Organsystem betreffen können. Die große Mehrheit der ICPi-behandelten Patienten erlebt ein irAE an mindestens einem Organsystem und davon weisen ca. 5–20% ein rheumatisches irAEs auf. Diese sind interessanterweise mit einem besseren Tumoransprechraten bei ICPi-Therapie assoziiert und können entweder die Erstmanifestation einer klassischen entzündlich-rheumatischen Erkrankung oder auch nur eine transiente Nebenwirkung mit spezifischen Charakteristika sein. Zweifelsohne wird das interdisziplinäre Management immunvermittelter Nebenwirkungen auch den Rheumatologen in den nächsten Jahren zunehmend beschäftigen. Der vorliegende Artikel fasst die Erkenntnisse zum klinischen Management von irAEs für den praktizierenden Rheumatologen zusammen.

Abstract

Cancer immunotherapy with immune checkpoint inhibitors (ICPi) as the major representatives of this novel substance class are increasingly applied in a growing number of solid and haematological malignancies and stages. Remarkable tumour response rates, even in advanced and refractory stages, have revolutionised the possibilities in the field of oncology. However, the increasing use of ICPi therapies also poses unprecedented challenges: immunotherapies cause a diverse spectrum of autoimmune side-effects, known as “immune-related adverse events” (irAEs), which resemble classic autoimmune diseases and involve virtually any organ system. The majority of ICPi-treated patients are affected by an irAE in at least one organ system and approx. 5–20% present with a rheumatic irAE. Interestingly, these are associated with better tumour response to ICPi therapy and can either be the initial manifestation of a classic rheumatic disease or only a transient side-effect with specific characteristics. Undoubtedly, the interdisciplinary management of immune-related side-effects will increasingly occupy rheumatologists in the coming years. This article summarises what practicing rheumatologists needs to know about the clinical management of irAEs.

Schlüsselwörter

Rheumatische irAEs - Rheumatische immunvermittelte Nebenwirkungen - Immunonkologische Therapie - Immuncheckpoint-Inhibitoren - Klinisches irAE-Management

Key words

rheumatic irAEs - cancer immunotherapy - immune checkpoint inhibitors - clinical irAE management - immunotherapy side-effects

Publication History

Article published online:
06 October 2020

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