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CC BY 4.0 · Brazilian Journal of Oncology 2017; 13(43): e-1792178
DOI: 10.1055/s-0044-1792178
Diretrizes

Diretrizes brasileiras de manejo de toxicidades imunomediadas associadas ao uso de bloqueadores de correceptores imunes

Brazilian guidelines for the management of immune-related adverse events associated with checkpoint inhibitors Grupo de Trabalho da Sociedade Brasileira de Oncologia Clínica
Fontes de financiamento: O presente projeto foi conduzido mediante patrocínio educacional da Merck Sharp & Dohme (MSD).
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RESUMO

Nos últimos anos, assistimos à consolidação da “imunoterapia” como uma forma efetiva e viável de se tratar o câncer. Em particular, a manipulação terapêutica de moléculas envolvidas na modulação da resposta imune com o uso de anticorpos monoclonais, ou bloqueadores de correceptores imunes, viabilizou uma nova realidade para pacientes com melanoma, câncer de pulmão e diversas outras neoplasias. Como exemplos, bloqueadores do cytotoxic T lymphocyte associated antigen 4 (CTLA-4) e programmed cell death protein 1 (PD-1) foram recentemente incorporados à prática clínica após aprovações por agências reguladoras no Brasil e em inúmeros outros países, e novas modalidades e combinações para a mobilização do sistema imunológico estão em estudo. Todavia, essa ativação imune, particularmente de linfócitos T, leva ao risco do desenvolvimento de respostas direcionadas a tecidos sadios que se manifestam clinicamente como eventos adversos imunomediados. Nesse contexto, o conhecimento do perfil de segurança desses fármacos e dos passos para o tratamento eficaz desses eventos adversos é fundamental, e ganhará ainda mais importância nos próximos anos, frente ao crescimento de indicações dos bloqueadores de correceptores imunes, do número de pacientes tratados com esses agentes e à sua incorporação à prática da oncologia. Com esse foco, a presente diretriz se propõe a discutir o espectro de toxicidades relacionadas ao uso de bloqueadores de correceptores imunes e as estratégias destinadas a permitir o seu diagnóstico precoce e manejo adequado.

ABSTRACT

In the past few years, we have witnessed the consolidation of "immunotherapy" as an effective and viable way of treating cancer. Therapeutic intervention using monoclonal antibodies targeting molecules that modulate the immune response, or immune co-receptors, broadened the clinical benefit expectations for patients affected by melanoma, lung cancer and several other neoplasms. As an example, cytotoxic T-lymphocyte associated antigen 4 (CTLA-4) and programmed cell death protein 1 (PD-1) blockers have been recently incorporated into clinical practice after approvalby the regulatory agencies in several countries, including Brazil, and new combination modalities for the engagement of the immune system are currently being studied. Nonetheless, immune activation, especially of T-lymphocytes, carries the risk of triggering responses towards healthy tissues, which are manifested as immune-mediated adverse events. In this context, learning the safety profile of these drugs and the stepwise management of adverse events is crucial. Over the next years, a rise in indications is expected, and consequently, consistent incorporation into the oncological practice and an increase in the number of treated patients are likely to occur. Therefore, the purpose of this guideline is to discuss the range of toxicities related to the use of immune co-receptor blockers and the strategies that allow their early diagnosis and proper management.

Descritores:

Imunoterapia - Antígeno CTLA-4 - Receptor de morte celular programada 1 - An-ticorpos monoclonais

Keywords:

Immunotherapy - CTLA-4 antigen - Programmed cell death 1 receptor - Antibodies, monoclonal


Publikationsverlauf

Eingereicht: 27. Februar 2017

Angenommen: 14. März 2017

Artikel online veröffentlicht:
07. März 2025

© 2017. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
. Diretrizes brasileiras de manejo de toxicidades imunomediadas associadas ao uso de bloqueadores de correceptores imunes. Brazilian Journal of Oncology 2017; 13: e-1792178.
DOI: 10.1055/s-0044-1792178
 

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