摘要：免疫检查点抑制剂属于单抗类药物，不同于传统的癌症治疗方法，其通过作用于免疫检查点进而获得疗 效，是临床上一种新的尝试。但由于免疫系统过度激活，导致的毒副反应多累及皮肤、胃肠道、肺、内分泌器 官、肝等，虽大多为轻度，但少数中重度毒副反应较易危及生命。因而，对于毒副反应的早期诊断和适当临床管 理显得尤为重要。论文重点对免疫检查点抑制剂在应用过程中的常见毒副反应和管理作一综述，以最大程度保障 其应用的安全性。

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苏非凡,双卫兵. 免疫检查点抑制剂的毒副反应及管理[J]. 泌尿外科杂志（电子版）,2021,13(2):73-80. DOI:10.3969/j.issn.1674-7410.2021.02.017.

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近年来，随着免疫检查点抑制剂（immune checkpoint inhibitors，ICIs） 研究的进展，免疫治疗成为 肿瘤治疗的一种新的方式。阿替利珠单抗、德瓦鲁 单抗、阿利库单抗、纳武利尤单抗和帕博利珠单抗 凭借Ⅰ期和Ⅱ期临床试验中的突破性数据，迅速被 FDA 批准用于化疗失败的晚期膀胱癌患者的二线治 疗。2017年，帕博利珠单抗与阿替利珠单抗被批准 用于不适于使用铂类药物的晚期膀胱癌患者的一线 治疗[1] 。随后又陆续研发出了替雷利珠单抗等多种品 种，并且 ICIs 的治疗适应证也在不断增加。然而， ICIs 在提高肿瘤疗效的同时，也可能因其特殊的作 用机制导致免疫系统紊乱发生免疫相关不良事件 （immune- related adverse events， irAEs）。 因 此 ， 正确认识 irAEs并恰当处理十分重要。

1 概述
    1.1 临床表现
    1.2 安全管理
        1.2.1 预防
        1.2.2 评估
        1.2.3 治疗
        1.2.4 监测

2 皮肤毒性 （dermal toxicity，DT）
2.1 临床表现
    2.2 DT 管理

3 胃肠道毒性 （gastrointestinal toxicity，GT）
    3.1 临床表现
    3.2 GT 管理

4 肺毒性
    4.1 临床表现
    4.2 肺毒性管理

5 肝毒性
    5.1 临床表现
    5.2 肝毒性管理

6 内分泌相关毒性
    6.1 甲状腺功能障碍
        6.1.1 临床表现
        6.1.2 管理
    6.2 垂体炎
        6.2.1 临床表现
        6.2.2 管理
    6.3 IDD
        6.3.1 临床表现
        6.3.2 管理
    6.4 PAI
        6.4.1 临床表现
        6.4.2 管理

7 心脏毒性
    7.1 临床表现
    7.2 心脏毒性管理

8 结语与展望

8 结语与展望 

相对于传统治疗手段来说，ICIs 的耐受性较 好，且大多数 irAEs是轻微症状且可逆的，早期发现 和及时干预，便可减少其毒副反应。但是药物的疗 效是因肿瘤类型和个体之间的不同是存在差异的。 对具体患者而言，并非所有患者都可获益。关于 ICIs 仍有很多有待解决的问题。如何选择合适的治 疗人群、irAEs的发生机制、评估原则、使用原则尚 不清晰，如何避免不良反应也将是今后研究的重点。

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