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Nebenwirkungen der Immun-Checkpoint-Inhibitoren

Adverse events of immune checkpoint inhibitors

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Zusammenfassung

Nach Zulassung der Immun-Checkpoint-Inhibitortherapie für das Nierenzellkarzinom im vergangenen Jahr findet diese „neue Immuntherapie“ nun weitere Verbreitung in der Urologie. Noch 2017 werden für das metastasierte Urothelkarzinom nach platinbasierter Vortherapie Zulassungen (Atezolizumab, Nivolumab, Pembrolizumab) erwartet. Mit zunehmendem Einsatz der Immun-Checkpoint-Inhibitoren steigen auch die Erfahrungen bezüglich Diagnostik und Management von immunvermittelten Nebenwirkungen. Obwohl von niedriger Inzidenz sind Grad-3/4-Nebenwirkungen von zentraler Bedeutung. Vorrangig sind Haut, Darm (Diarrhö, Kolitis), Leber, Lunge, endokrines System (Hypophysitis, Hyper-, Hypothyreose) und Niere betroffen. Die Diagnostik umfasst neben Routinelaborparametern einschließlich der Leberwerte ggf. auch zusätzlich Hormonwerte. Insbesondere bei der Pneumonitis sowie der Hypophysitis kann eine Bildgebung (High-resolution[HR]-Computertomographie [CT], Magnetresonanztomographie [MRT]) die Diagnose bestätigen. Die Behandlung immunvermittelter Nebenwirkungen setzt sich aus Therapieunterbrechung und der Gabe von Kortikosteroiden und ggf. weiteren Immunsuppressiva zusammen. Dosisanpassungen werden nicht vorgenommen.

Abstract

After immune checkpoint inhibitor therapy was approved for renal cell carcinoma last year, this new immune therapy has spread to urology. Further approvals (atezolizumab, nivolumab, pembrolizumab) are expected in 2017 for metastatic urothelial carcinoma that has progressed following treatment with platinum-based chemotherapy. With expanding use of immune checkpoint inhibitors, experience in diagnosing and managing immune-mediated adverse events increases. Although of low incidence, grade 3/4 toxicities play a central role. Organs most common for immune-mediated adverse events are skin, liver (hepatitis), kidneys (nephritis), gastrointestinal tract (diarrhea and colitis), lungs (pneumonitis), and endocrine organs (hyper-, hypothyroidism and hypophysitis). Diagnostic workup includes routine laboratory tests (including liver function tests) and may be supplemented with hormone values. In cases of pneumonitis or hypophysitis, imaging (high-resolution CT, MRI) can confirm diagnoses. Immune-mediated toxicities are treated with therapy interruption and administration of corticosteroids (and in individual cases additional immunosuppression). Dose modification is not intended!

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Authors and Affiliations

  1. Urologische Klinik und Poliklinik, Universitätsklinikum Jena, Lessingstraße 1, 07743, Jena, Deutschland

    S. Foller, H. Oppel-Heuchel, I. Fetter, Y. Winkler & M.-O. Grimm

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  1. S. Foller
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  2. H. Oppel-Heuchel
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  3. I. Fetter
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  4. Y. Winkler
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  5. M.-O. Grimm
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Correspondence to S. Foller.

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Interessenkonflikt

S. Foller ist als Referent für folgende Firmen tätig gewesen: Pfizer, Bristol-Myers-Squibb, Novartis, Astellas, Roche, Jannsen, Bayer Health Care. H. Oppel-Heuchel ist als Referent für die Firmen Pfizer, Bristol-Myers Squibb und Novartis tätig gewesen. M.-O. Grimm ist als Referent und Berater für folgende Firmen tätig gewesen: Astra Zeneca, Bayer Health Care, Bristol-Myers Squibb, GlaxoSmithKline, Novartis, Pfizer, Pierre Fabre (Referent). I. Fetter und Y. Winkler geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Foller, S., Oppel-Heuchel, H., Fetter, I. et al. Nebenwirkungen der Immun-Checkpoint-Inhibitoren. Urologe 56, 486–491 (2017). https://doi.org/10.1007/s00120-017-0342-3

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  • DOI: https://doi.org/10.1007/s00120-017-0342-3

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