Characterisation of rare haematological immune-related toxicities
Menée en France à partir de données portant sur 948 patients atteints de cancer, cette étude analyse les événements indésirables de nature immunitaire et hématologique liés à une immunothérapie par anti-PD-1 et anti-PD-L1
The 2018 Nobel laureates James Allison and Tasuku Honjo pioneered the use of negative immune regulation to fight cancer. This work led to the development of antibodies targeting the immune checkpoint cytotoxic T-lymphocyte protein 4 (CTLA4) and programmed cell death 1 (PD-1) or programmed cell death ligand 1 (PD-L1). Targeting of the PD-1 pathway or combining anti-CTLA4 with anti-PD-1 or anti-PD-L1 therapy are new treatment strategies that have revolutionised cancer treatment. Both patients with rare cancers (eg, Merkel cell carcinoma) and those with common cancers (eg, non-small-cell lung cancer) benefit from these treatments. However, blockade of immune checkpoints, which normally control peripheral immune tolerance, comes at a price. Anti-PD-1 or anti-PD-L1 treatment occasionally results in severe immune-related toxicities. These events can occur any time after initiation of treatment, even months after stopping treatment, but most commonly develop within the first 3–6 months of therapy. The toxicities resemble autoimmune diseases, but usually have a more sudden onset and do not continue long term. If managed properly, aggressively, and promptly, they can resolve completely within weeks, although some specific autoimmune damage (especially endocrinopathies such as hypothyroidism, hypoadrenalism, and type 1 diabetes) require lifelong substitution therapy. Algorithms have been developed to properly manage these toxicities. However, as more and more patients are treated in academic and community settings with anti-PD-1 or anti-PD-L1 drugs (either as monotherapy or in combination with chemotherapy, anti-CTLA4, or with new immunotherapeutic compounds), more doctors and patients will be confronted with these rare toxicities
The Lancet Haematology , commentaire, 2017