Abstract：
Immune checkpoint inhibitors (ICIs) are a novel class of drugs used in cancer immunotherapy that are becoming more commonly used among advanced-stage cancers. Unfortunately, these therapies are sometimes associated with often subtle, potentially fatal immune-related adverse events (irAEs).
We conducted a review of relevant primary research and clinical guidelines in oncology, pharmacology, and other literature, and synthesized this information to address the needs of the emergency physician in the acute management of irAEs.
Although the antitumor effects of immunotherapies are desirable, the inhibition of immune checkpoints may also lead to loss of peripheral tolerance and a subsequent unleashing of the immune system on nontumor cells, leading to unintended tissue damage, which manifests as multisystem organ dysfunction. This tissue damage can affect nearly every organ system, with the dermatologic, gastrointestinal, endocrine, and pulmonary systems being the most commonly affected. Treatment may range drastically, depending on the severity of the irAE, starting with supportive care and moving toward high-dose steroids and additional immune modulators such as infliximab or intravenous immunoglobulin.
With the increasing success and popularity of ICIs, emergency physicians will inevitably encounter increasing numbers of patients on these medications as well as the associated side effects. It is important that emergency physicians become aware of these irAEs and improve the detection of these processes to prevent inappropriate discharges, emergency department revisits, and downstream complications.
We conducted a review of relevant primary research and clinical guidelines in oncology, pharmacology, and other literature, and synthesized this information to address the needs of the emergency physician in the acute management of irAEs.
Although the antitumor effects of immunotherapies are desirable, the inhibition of immune checkpoints may also lead to loss of peripheral tolerance and a subsequent unleashing of the immune system on nontumor cells, leading to unintended tissue damage, which manifests as multisystem organ dysfunction. This tissue damage can affect nearly every organ system, with the dermatologic, gastrointestinal, endocrine, and pulmonary systems being the most commonly affected. Treatment may range drastically, depending on the severity of the irAE, starting with supportive care and moving toward high-dose steroids and additional immune modulators such as infliximab or intravenous immunoglobulin.
With the increasing success and popularity of ICIs, emergency physicians will inevitably encounter increasing numbers of patients on these medications as well as the associated side effects. It is important that emergency physicians become aware of these irAEs and improve the detection of these processes to prevent inappropriate discharges, emergency department revisits, and downstream complications.
摘要：
免疫检查点抑制剂（ICIs）是癌症免疫治疗中使用的一类新型药物，在晚期癌症中越来越普遍使用。不幸的是,这些疗法有时与通常微妙的，潜在致命的免疫相关不良事件（irAEs）。
我们对肿瘤学的相关主要研究和临床指南进行了综述，药理学,和其他文学，并综合这些信息以满足急诊医师在急性处理irAE中的需求。
虽然免疫疗法的抗肿瘤作用是可取的，免疫检查点的抑制也可能导致外周耐受性的丧失和随后的非肿瘤细胞的免疫系统的释放，导致意外的组织损伤，表现为多系统器官功能障碍。这种组织损伤可以影响几乎每个器官系统，皮肤病学，胃肠,内分泌，和肺系统是最常见的影响。治疗范围可能很大，根据IRAE的严重程度，从支持治疗开始，转向高剂量类固醇和其他免疫调节剂，如英夫利昔单抗或静脉注射免疫球蛋白。
随着ICI的日益成功和普及，急诊医生将不可避免地遇到越来越多的患者使用这些药物以及相关的副作用。重要的是，急诊医生要意识到这些irAE，并改善这些过程的检测，以防止不适当的放电，急诊科重访，下游并发症。
我们对肿瘤学的相关主要研究和临床指南进行了综述，药理学,和其他文学，并综合这些信息以满足急诊医师在急性处理irAE中的需求。
虽然免疫疗法的抗肿瘤作用是可取的，免疫检查点的抑制也可能导致外周耐受性的丧失和随后的非肿瘤细胞的免疫系统的释放，导致意外的组织损伤，表现为多系统器官功能障碍。这种组织损伤可以影响几乎每个器官系统，皮肤病学，胃肠,内分泌，和肺系统是最常见的影响。治疗范围可能很大，根据IRAE的严重程度，从支持治疗开始，转向高剂量类固醇和其他免疫调节剂，如英夫利昔单抗或静脉注射免疫球蛋白。
随着ICI的日益成功和普及，急诊医生将不可避免地遇到越来越多的患者使用这些药物以及相关的副作用。重要的是，急诊医生要意识到这些irAE，并改善这些过程的检测，以防止不适当的放电，急诊科重访，下游并发症。
