İmmünoterapilerin Yan Etkileri ve Acil Serviste Yönetimi

Year 2023, , 179 - 185, 29.12.2023

Nalan Metin Aksu , Elif Öztürk İnce

https://doi.org/10.54996/anatolianjem.1406954

Abstract

İmmünoterapiler son zamanlarda bir çok kanser tipinde ( küçük hücreli olmayan akciğer ca, renal hücreli ca, malign melanom, hodgkin lenfoma gibi) tedavide önemli rol oynamaktadır. İmmüncheckpoint inhibitörleri (ir) reseptörlerine bağlandıklarında tümör dokusunda hücrelerin aşırı yanıt vermesini sağlayan sinyalleri önler ve inflamatuar yanıt sürecinde oluşan doku hasarını sınırlar. Bu tedaviyi alan hastaların Acil Servis başvuruları da tedavinin yaygınlığı arttıkça artmaktadır. irAE çok geniş bir spektrumu içermektedir. Kardiyak yan etkiler-myokardit ve buna bağlı oluşabilecek disritmiler, akut koroner sendrom, perikardiyal sıvı ve perikardit; torasik yan etkiler- pnömonitis, pulmoner hemoraji, sarkoid benzeri akciğer tutulumu, vaskülit, pulmoner tromboemboli; infeksiyöz yan etkiler- nötropeni (nadir),CMV koliti, Clostridium difficile’ e bağlı ishal, mikobakteriel infeksiyonlar; romatolojik yan etkiler- artrit, miyozit, polimiyaljia rheumatika; dermatolojik yan etkiler-vitiligo, liken, dermatomiyozit, Steven-Johnson sendromu; oküler yan etkile- üveit, optik sinir hastalıkları, koryoretinal lezyonlar.Hastaların yönetimi yakınmalarına ve muhtemel yan etkiye bağlı olarak değişmektedir ama daha çok kullanılan steroid tedavisidir. Hastaların yönetimi primer onkoloji doktorları ile konsülte edilerekyürütülmelidir

Keywords

İmmunoterapi, yan etki, acil servis

Side Effects of Immunotherapies and Management in the Emergency Department

Abstract

Immunotherapies have recently played an important role in the treatment of many types of cancer (such as non-small cell lung cancer, renal cell cancer, malignant melanoma, Hodgkin lymphoma). When immunocheckpoint inhibitors (IR) bind to their receptors, they prevent the signals that cause cells to overreact in the tumor tissue and limit the tissue damage that occurs during the inflammatory response process. Emergency Department visits of patients receiving this treatment also increase as the prevalence of the treatment increases. irAE covers a very broad spectrum. Cardiac side effects - myocarditis and related dysrhythmias, acute coronary syndrome, pericardial fluid and pericarditis; thoracic side effects - pneumonitis, pulmonary hemorrhage, sarcoid-like lung involvement, vasculitis, pulmonary thromboembolism; infectious side effects - neutropenia (rare), CMV colitis, diarrhea due to Clostridium difficile, mycobacterial infections; rheumatological side effects - arthritis, myositis, polymyalgia rheumatica; dermatological side effects-vitiligo, lichen, dermatomyositis, Steven-Johnson syndrome; Ocular side effects - uveitis, optic nerve diseases, chorioretinal lesions. Management of patients varies depending on their complaints and possible side effects, but the most used is steroid treatment. Management of patients should be carried out in consultation with primary oncology doctors.

Keywords

Immunotherapy, side effect, emergency medicine department

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