medicina61巻3号

2024年03月発行

特集 どこでもみれる?—コモンディジーズとしての感染症アップデート ブレイクスルーと感染症

免疫チェックポイント阻害薬と感染症

著者： 武田孝一¹²

所属機関： ¹がん研究会有明病院感染症科 ²がん研究会有明病院腫瘍リウマチ膠原病科

ページ範囲：P.554 - P.559

Point
◎免疫チェックポイント阻害薬の機序と，その特異的な副作用である免疫関連有害事象（irAE）を理解する．
◎免疫チェックポイント阻害薬そのものに感染症リスクは（おそらく）ないが，合併したirAEに対してステロイド/免疫抑制薬/生物学的製剤を使用した場合は，（特に細胞性免疫不全状態の）感染症に注意する．
◎irAEのうち，臨床像が感染症に類似するものが複数存在する．

参考文献

1）Tison A, et al：Immune-checkpoint inhibitor use in patients with cancer and pre-existing autoimmune diseases. Nat Rev Rheumatol 18：641-656, 2022 PMID 36198831

2）de La Rochefoucauld J, et al：Management of immune-related adverse events associated with immune checkpoint inhibitors in cancer patients；A patient-centred approach. Intern Emerg Med 15：587-598, 2020 PMID 32144552

3）Yin Q, et al：Immune-related adverse events of immune checkpoint inhibitors；A review. Front Immunol 14：1167975, 2023 PMID 37304306

4）Goodman RS, et al：Corticosteroids and cancer immunotherapy. Clin Cancer Res 29：2580-2587, 2023 PMID 36648402

5）Liu W, et al：Current landscape and tailored management of immune-related adverse events. Front Pharmacol 14：1078338, 2023 PMID 36950013

6）Raschi E, et al：Lessons to be learnt from real-world studies on immune-related adverse events with checkpoint inhibitors；A clinical perspective from pharmacovigilance. Target Oncol 15：449-466, 2000 PMID 32725437

7）Postow MA, et al：Immune-related adverse events associated with immune checkpoint blockade. N Engl J Med 378：158-168, 2018 PMID 29320654

8）Owen CN, et al：Delayed immune-related adverse events with anti-PD-1-based immunotherapy in melanoma. Ann Oncol 32：917-925, 2021

9）Thompson JA, et al：NCCN Guidelines Index Table of Contents Discussion, 2023

10）Couey MA, et al：Delayed immune-related events（DIRE）after discontinuation of immunotherapy；Diagnostic hazard of autoimmunity at a distance. J Immunother Cancer 7：165, 2019 PMID 31269983

11）Del Castillo M, et al：The spectrum of serious infections among patients receiving immune checkpoint blockade for the treatment of melanoma. Clin Infect Dis 63：1490-1493, 2016 PMID 27501841

12）Winthrop KL, et al：Opportunistic infections and biologic therapies in immune-mediated inflammatory diseases；Consensus recommendations for infection reporting during clinical trials and postmarketing surveillance. Ann Rheum Dis 74：2107-2116, 2015 PMID 26395500

13）Lee JJX, et al：Tuberculosis reactivation in a patient receiving anti-programmed death-1（PD-1）inhibitor for relapsed Hodgkin's lymphoma. Acta Oncol 55：519-520, 2016 PMID 26754959

14）Fujita K, et al：Anti-PD1 antibody treatment and the development of acute pulmonary tuberculosis. J Thorac Oncol 11：2238-2240, 2016 PMID 27423391

15）Chu YC, et al：Pericardial tamponade caused by a hypersensitivity response to tuberculosis reactivation after anti-PD-1 treatment in a patient with advanced pulmonary adenocarcinoma. J Thorac Oncol 12：e111-e114, 2017 PMID 28748816

16）Jensen KH, et al：Development of pulmonary tuberculosis following treatment with anti-PD-1 for non-small cell lung cancer. Acta Oncol 57：1127-1128, 2018 PMID 29384034

17）Uchida N, et al：Acute progression of aspergillosis in a patient with lung cancer receiving nivolumab. Respirol Case Rep 6：e00289, 2018 PMID 29321933

18）Anastasopoulou A, et al：Cytomegalovirus infections in patients treated with immune checkpoint inhibitors for solid malignancies. Open Forum Infect Dis 10：ofad164, 2023 PMID 37065986

19）Redelman-Sidi G, et al：ESCMID Study Group for Infections in Compromised Hosts（ESGICH）Consensus Document on the safety of targeted and biological therapies；An infectious diseases perspective（Immune checkpoint inhibitors, cell adhesion inhibitors, sphingosine-1-phosphate receptor modulators and proteasome inhibitors）. Clin Microbiol Infect 24 Suppl 2：S95-S107, 2018 PMID 29427804

20）Davis JS, et al：Infectious complications of biological and small molecule targeted immunomodulatory therapies. Clin Microbiol Rev 33：e00035-19, 2020 PMID 32522746