Abstract：
Immune checkpoint inhibitors (ICIs) affect immunologic homeostasis, leading to immune-related adverse events (irAEs). Early irAE detection and management can prevent significant morbidity and mortality. A retrospective chart review was performed to characterize irAEs associated with nivolumab, ipilimumab, and nivolumab plus ipilimumab in adult medical oncology patients in Nova Scotia Health-Central Zone from 2013-2020, and to describe adherence to toxicity management guidelines. Diarrhea/colitis, hepatitis, pneumonitis, nephrotoxicity, and cardiotoxicity were studied. Of 129 charts reviewed, 67 patients (51.9%) experienced at least one irAE for a total of 98 irAEs and a 1.5% fatality rate. Of these irAEs, 33.7% led to an emergency room visit. Patients were admitted to hospital and steroids were used in 24.5% and 35.7% of cases, respectively. In 17.3% of irAEs, ICIs were permanently discontinued. In 20.4% of irAEs, ICIs were held, and patients were monitored; while in 18.4%, ICIs were held until the irAE was Grade 0-1 (and until steroids were tapered). Almost 47% of irAEs were managed according to guidelines (14.3% were not), and 38.8% had no documented management. Patients receiving immunotherapy frequently experience irAEs with half of irAEs having documented management adhering to guidelines. As immunotherapy indications expand, it is important to ensure irAEs are documented and managed appropriately.
摘要：
免疫检查点抑制剂（ICIs）影响免疫稳态，导致免疫相关不良事件（irAE）。早期的irAE检测和管理可以预防显著的发病率和死亡率。进行了回顾性图表审查，以描述与纳武单抗相关的irAE，ipilimumab,和nivolumab+ipilimumab在2013-2020年新斯科舍省健康中心区成人肿瘤患者中的应用,并描述对毒性管理指南的遵守情况.腹泻/结肠炎，肝炎，肺炎,肾毒性，和心脏毒性进行了研究。在审查的129张图表中，67名患者（51.9%）经历了至少一次irAE，总共98次irAE，死亡率为1.5%。在这些iRAE中，33.7％导致急诊室就诊。患者入院，分别有24.5%和35.7%的患者使用类固醇，分别。在17.3%的钢铁中，ICIs被永久终止。在20.4%的IRAE中，ICIs举行，并对患者进行了监测；而在18.4%的患者中，保持ICIs直到irAE为0-1级(并且直到类固醇逐渐变细)。几乎47%的irAE根据指导方针进行了管理(14.3%没有)，38.8%没有记录的管理。接受免疫治疗的患者经常经历irAE，其中一半的irAE具有遵守指南的记录管理。随着免疫治疗适应症的扩大，重要的是要确保对iRAE进行记录和适当管理。
