Nebenwirkungsmanagement in der Immunonkologie

Abstract

The immune oncological treatment approach uses immune checkpoint inhibitors to prevent tumor cells from shutting down the immune system, and thus from escaping immune response. Following the clinical success of immune checkpoint inhibitors, the number of approved immune oncological therapies continues to increase. Response rates and overall survival with anti-PD-1/PD-L1 and CTLA-4 blockade could be further improved by combining both treatment approaches. However, checkpoint inhibition is associated with a unique spectrum of side effects termed immune-related adverse events. These typically occur 3 to 6 months after treatment start and resolve with adequate management procedures if detected early on. Therefore, profound patient education, sensitizing and monitoring are mandatory. We describe in this article selected frequent and rare adverse events that are clinically relevant. Furthermore, using case reports, interdisciplinary experts share their practice-based experience in the management of frequent pneumonic, endocrine, and gastro-intestinal immune-related adverse events.

Aufgrund ihres Wirkmechanismus an den Effektorzellen des Immunsystems haben Immuncheckpoint-Inhibitoren (CPI) ein einzigartiges Nebenwirkungsprofil. Die meisten dieser immunvermittelten Nebenwirkungen (imUE) treten 3 – 6 Monate nach Therapiebeginn auf. Frühzeitig erkannt sind sie in der Regel bei geeignetem Management reversibel. Daher sind eine gründliche Aufklärung, Sensibilisierung sowie ein regelmäßiges Monitoring der Patienten notwendig.

Schlüsselwörter

Immuncheckpoint-Inhibitoren - CPI - immunvermittelte Nebenwirkung - imUE - NW - PD-1/PD-L1 - CTLA-4 - NW-Management

Key words

immune checkpoint inhibitor - immune-related adverse event - PD-1/PD-L1 - CTLA-4 - adverse event management

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