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Efeitos adversos renais da imunoterapia oncológica
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O sistema imune possui um papel crítico, não só a proteger-nos contra doenças infeciosas, como também, de tumores. Sabe-se há muitos anos que o sistema imunitário desempenha um papel importante no desenvolvimento e controlo neoplásico. A imunossupressão está associada a um risco superior de cancro, e a regressão espontânea de muitos tipos de tumores malignos é um fenómeno raro, mas bem reconhecido.
A imunoterapia oncológica revolucionou a oncologia prolongando a sobrevivência de pacientes com tumores rapidamente fatais e pode ser definida como a utilização de características do sistema imunitário no tratamento do cancro. O número de pacientes com cancro elegíveis para imunoterapia tem aumentado, estando estas terapias indicadas como primeira linha em diversos tipos de cancro.
O Interferão e a alta dose de interleucina 2 constituem imunoterapias mais antigas utilizadas na prática clínica para tratar várias doenças malignas. Na última década surgiram novas imunoterapias oncológicas que oferecem opções de tratamento ainda mais eficazes, tal como os inibidores do checkpoint imunológico. As células T com recetores quiméricos de antigénio são também uma nova imunoterapia utilizada para tratar várias neoplasias hematológicas. No entanto, tal como com os agentes anti tumorais convencionais, as imunoterapias estão também associadas a efeitos adversos em particular, relacionados com alteração da função renal. Estes efeitos continuam a ser menos bem descritos do que os efeitos adversos nos sistemas de órgãos de barreira, tais como o trato gastrointestinal e a pele.
Este trabalho pretende conduzir a um reconhecimento e monitorização mais precoce destes efeitos o que se torna importante à medida que a sobrevivência pós-tumor aumenta, deixando os pacientes a lidar com as consequências não só do cancro, mas também dos efeitos adversos do tratamento a curto e longo prazo. Nesta revisão são discutidos os principais efeitos adversos renais relacionados com diversos tipos de imunoterapia.
The immune system plays a critical role, not only protecting us against infectious diseases, but also tumors. It has been known for many years that the immune system plays an important role in neoplastic development and control. Immunosuppression is associated with a higher risk of cancer, and spontaneous regression of many types of malignant tumors is a rare but well-recognized phenomenon. Cancer immunotherapy has revolutionized oncology by prolonging the survival of patients with rapidly fatal tumors and can be defined as the use of characteristics of the immune system in the treatment of cancer. The number of cancer patients eligible for immunotherapy has increased, and these therapies are indicated as first line in several types of cancer. IFN and high-dose IL-2 constitute older immunotherapies used in clinical practice to treat various malignancies. In the last decade new cancer immunotherapies have emerged that offer even more effective treatment options, such as immune checkpoint inhibitors. T cells with chimeric antigen receptors are also a new immunotherapy used to treat various hematologic malignancies. However, as with conventional tumor agents, immunotherapies are also associated with adverse effects in particular, related to altered renal function. These effects remain less well described than adverse effects on barrier organ systems such as the gastrointestinal tract and skin. This work may lead to earlier recognition and monitoring of these effects which becomes particularly important as post-tumor survival increases, leaving patients to deal with the consequences of not only the cancer, but also the short- and long-term adverse effects of treatment. In this review the major renal adverse effects related to various types of immunotherapies are discussed.
The immune system plays a critical role, not only protecting us against infectious diseases, but also tumors. It has been known for many years that the immune system plays an important role in neoplastic development and control. Immunosuppression is associated with a higher risk of cancer, and spontaneous regression of many types of malignant tumors is a rare but well-recognized phenomenon. Cancer immunotherapy has revolutionized oncology by prolonging the survival of patients with rapidly fatal tumors and can be defined as the use of characteristics of the immune system in the treatment of cancer. The number of cancer patients eligible for immunotherapy has increased, and these therapies are indicated as first line in several types of cancer. IFN and high-dose IL-2 constitute older immunotherapies used in clinical practice to treat various malignancies. In the last decade new cancer immunotherapies have emerged that offer even more effective treatment options, such as immune checkpoint inhibitors. T cells with chimeric antigen receptors are also a new immunotherapy used to treat various hematologic malignancies. However, as with conventional tumor agents, immunotherapies are also associated with adverse effects in particular, related to altered renal function. These effects remain less well described than adverse effects on barrier organ systems such as the gastrointestinal tract and skin. This work may lead to earlier recognition and monitoring of these effects which becomes particularly important as post-tumor survival increases, leaving patients to deal with the consequences of not only the cancer, but also the short- and long-term adverse effects of treatment. In this review the major renal adverse effects related to various types of immunotherapies are discussed.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Immunoediting Efeitos adversos renais Imunoterapia Terapêuticas oncológicas Onconefrologia Nefrologia