医药导报2025，Vol.44Issue(6)：841-846,6.DOI:10.3870/j.issn.1004-0781.2025.06.001
CSCO和NCCN及ASCO指南对免疫检查点抑制剂相关肝毒性管理的比较
Comparison of Immune Checkpoint Inhibitor-related Hepatotoxicity Management Among CSCO,NCCN and ASCO Guidelines
邹海 1杨云松 2陈臻瑶 3李新艳 4郑永法 5朱彪1
作者信息
- 1. 复旦大学附属肿瘤医院重症监护室,上海 200032||复旦大学肿瘤学系,上海 200032
- 2. 复旦大学肿瘤学系,上海 200032||复旦大学附属肿瘤医院乳腺科,上海 200032
- 3. 上海市胸科医院呼吸科,上海 200030
- 4. 上海市公共卫生临床中心肝病科,上海 200093
- 5. 武汉大学人民医院肿瘤中心,武汉 430060
- 折叠
摘要
Abstract
Immune checkpoint inhibitors(ICIs)represent the most widely used immunotherapeutic approach for antitumor treatment,yet the understanding of their associated hepatotoxicity remains incomplete.This article delves into and analyzes the similarities and differences among the management guidelines on ICI-related hepatotoxicity issued by the Chinese Society of Clinical Oncology(CSCO),the National Comprehensive Cancer Network(NCCN)of the United States,and the American Society of Clinical Oncology(ASCO),aiming to provide a more comprehensive management strategy for clinical practice.By reviewing and analyzing the latest guidelines,this study compares the differences and similarities in the diagnosis,assessment,grading criteria,and treatment strategies for ICI-related liver toxicity among these guidelines.The definitions and diagnostic criteria for ICI-related liver toxicity are generally consistent across different guidelines,primarily relying on the elevated levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),bilirubin,and alkaline phosphatase(ALP)for grading.Notably,the ASCO guidelines place a stronger emphasis on the assessment of symptoms of hepatic dysfunction.In terms of treatment strategies,all guidelines recommend using corticosteroids or immunosuppressants based on the toxicity grade.However,there are discrepancies in management strategies among the guidelines.Clinicians should tailor management strategies by considering the specific conditions of patients and integrating the recommendations from various guidelines.Additionally,given the current inadequate understanding of ICI-induced hepatotoxicity primarily manifested as cirrhosis in the existing guidelines,it is imperative to continuously update and refine these management guidelines as research progresses and clinical experience accumulates.关键词
免疫检查点抑制剂/肝毒性/临床指南/免疫相关不良事件/癌症免疫治疗Key words
Immune checkpoint inhibitors/Hepatotoxicity/Clinical practice guidelines/Immune-related adverse events/Cancer immunotherapy分类
医药卫生引用本文复制引用
邹海,杨云松,陈臻瑶,李新艳,郑永法,朱彪..CSCO和NCCN及ASCO指南对免疫检查点抑制剂相关肝毒性管理的比较[J].医药导报,2025,44(6):841-846,6.
