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首页> 外文期刊>Endocrinology, Diabetes & Metabolism >Rethinking the management of immune checkpoint inhibitor-related adrenal insufficiency in cancer patients during the COVID-19 pandemic
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Rethinking the management of immune checkpoint inhibitor-related adrenal insufficiency in cancer patients during the COVID-19 pandemic

机译：重新思考Covid-19大流行期间癌症患者免疫检查点抑制剂相关肾上腺功能不全的管理

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Introduction The coronavirus disease 2019 (COVID-19) is currently a major pandemic challenge, and cancer patients are at a heightened risk of severity and mortality from this infection. In recent years, immune checkpoint inhibitor (ICI) use to treat multiple cancers has increased in oncology, but equally has raised the question of whether ICI therapy and its side-effects is harmful or beneficial during this pandemic. Methods A combination of published literature in PubMed between January 2010 and December 2020, recommended guidelines in non-cancer patients, and clinical experience was utilized to outline recommendations on glucocorticoid timing and dosing regimens in ICI-treated patients presenting with AI during this COVID-19 pandemic. Results The potential immune interaction between ICIs and COVID-19 require major consideration because these agents act at the intersection between effective cancer immunotherapy and increasing patient susceptibility, severity and complications from the SARS-CoV-2 sepsis. Furthermore, ICI use can induce autoimmune adrenal insufficiency (AI) that further increases infection susceptibility. Thus, ICI-treated cancer patients with AI may be at greater risk of COVID-19 infection. Glucocorticoids are the cornerstone for replacement therapy, and for treatment and mitigation of adrenal crisis and relief of mass effects in ICI-related hypophysitis. High-dose glucocorticoids have also been used with cytotoxic chemotherapy as part of cancer treatment, and iatrogenic AI may arise after glucocorticoid discontinuation that increases the risk of adrenal crisis. Furthermore, in patients who develop the “long COVID-19” syndrome, when to discontinue glucocorticoid therapy becomes crucial to avoid unnecessary prolongation of therapy and the development of iatrogenic hypercortisolemia. Conclusion During the COVID-19 pandemic, much of cancer care have been impacted and an important clinical question is how to optimally manage ICI-related AI during these unprecedented times. Herein, we suggest practical recommendations on the timing and dosing regimens of glucocorticoids in different clinical scenarios of ICI-treated cancer patients presenting with AI during this COVID-19 pandemic.
机译：引言冠状病毒疾病2019（Covid-19）目前是一个主要的大流行挑战，癌症患者从这种感染的严重程度和死亡率的风险增加。近年来，免疫检查点抑制剂（ICI）用于治疗多种癌症在肿瘤学中增加，但同样提出了ICI治疗和其副作用在这种大流行期间有害或有益的问题。方法对2010年1月和12月20日至12月20日之间的发布文献中发表的文献组合，推荐的非癌症患者指南，以及临床经验，概述了在此Covid-19期间呈现AI的ICI治疗患者中的糖皮质激素正时序和给药方案的建议大流行。结果ICIS和Covid-19之间的潜在免疫互动需要重大考虑，因为这些代理在有效癌症免疫疗法之间的交叉处行事，增加了SARS-COV-2败血症的患者易感性，严重程度和并发症。此外，ICI使用可以诱导自身免疫肾上腺功能不全（AI），进一步提高感染易感性。因此，ICI治疗的癌症患者AI可能具有更大的Covid-19感染风险。糖皮质激素是替代疗法的基石，以及治疗和减轻肾上腺危机和疾病与ICI相关的次体炎中的质量效果的缓解。作为癌症治疗的一部分，高剂量糖皮质激素也被用细胞毒性化学疗法使用，并且在糖皮质激素停止后可能会出现来自糖尿病危机的风险。此外，在开发“长Covid-19”综合征的患者中，何时停止糖皮质激素治疗变得至关重要，以避免不必要的治疗延长和性能性高血征的发育。结论在Covid-19大流行期间，大部分癌症护理受到影响，重要的临床问题是如何在这些前所未有的时期最佳地管理ICI相关的AI。在此，我们提出了关于在此Covid-19大流行期间患有AI的ICI治疗的癌症患者的不同临床情景中糖皮质激素的时序和给药方案的实用建议。

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