Understanding of immune-related adverse events (irAEs) has evolved rapidly, and management guidelines are continually updated. We explored temporal changes in checkpoint inhibitor-induced irAE management at a tertiary cancer care center to identify areas for improvement. We conducted a single-center retrospective study of patients who developed a gastrointestinal, pulmonary, renal, or cardiac irAE between July and 1 October in 2019 or 2021. We collected patient demographic and clinical information up to 1 year after toxicity. Endoscopic evaluation and specialty follow-up after discharge for patients with gastrointestinal irAEs declined between the 2019 and 2021 periods. Symptom duration and steroid taper attempts also declined. For pulmonary irAEs, rates of specialty consultation, hospital admission and readmission, and mortality improved in 2021 compared with 2019. Follow-up rates after hospital discharge were consistently low (<50%) in both periods. For cardiac irAEs, consultation with a cardiologist was frequent and prompt in both periods. Outpatient treatment and earlier specialty consultation improved outcomes with gastrointestinal irAEs. Our study exploring irAE practice changes over time identified areas to improve management; specifically, timely specialty consultation was associated with better outcomes for gastrointestinal irAEs. These findings can help improve the quality of management algorithms at our institution and may inform policies in other institutions.
对免疫相关不良事件（irAEs）的认识迅速发展，管理指南也在持续更新。本研究通过分析一家三级癌症诊疗中心在检查点抑制剂诱导的irAE管理实践中的时序变化，以识别可改进的领域。我们对2019年或2021年7月至10月1日期间发生胃肠道、肺部、肾脏或心脏irAE的患者进行了单中心回顾性研究，收集了毒性发生后长达1年的患者人口统计学和临床信息。研究发现，在2019年至2021年间，胃肠道irAE患者出院后的内镜评估和专科随访率有所下降，症状持续时间和类固醇减量尝试也有所减少。对于肺部irAE，2021年的专科会诊率、住院与再住院率以及死亡率较2019年均有所改善，但两个时期出院后的随访率均持续偏低（<50%）。对于心脏irAE，两个时期均能频繁且及时地获得心脏病专家会诊。研究显示，门诊治疗和早期专科会诊改善了胃肠道irAE的临床结局。本研究通过探索irAE管理实践随时间的变化，明确了需改进的领域：特别是及时专科会诊与胃肠道irAE更好的预后相关。这些发现有助于提升本机构管理方案的质量，并可为其他机构的政策制定提供参考。
肿瘤(癌症)患者之家