総説・解説等

永寿総合病院と慶応大学病院に通院している75歳以上の肺MAC症患者84例を対象とし、健康関連QOLの調査をSF-36とSGRQで行った。SF-36の値を日本の70歳代平均値と比較したところ、[RP][GH][VT][SF][RE][RCS]が有意に低値であった。1年間経過観察できた49例を対象とし、MACに対する抗菌薬治療が6ヵ月以上行われた群21例(治療介入群)と、無治療または治療期間6ヵ月未満の群28例(非介入群)に分け、健康関連QOLの経時的変化を調べた。結果、SF-36は治療介入群で有意な変化なく、非介入群で[PF][VT][MCS]が有意に増悪していた。SGRQは治療介入群で[Activity]と[Total]が有意に増悪し、非介入群では有意な変化は認めなかった。

永寿総合病院と慶応大学病院に通院している75歳以上の肺MAC症患者84例を対象とし、健康関連QOLの調査をSF-36とSGRQで行った。SF-36の値を日本の70歳代平均値と比較したところ、[RP][GH][VT][SF][RE][RCS]が有意に低値であった。1年間経過観察できた49例を対象とし、MACに対する抗菌薬治療が6ヵ月以上行われた群21例(治療介入群)と、無治療または治療期間6ヵ月未満の群28例(非介入群)に分け、健康関連QOLの経時的変化を調べた。結果、SF-36は治療介入群で有意な変化なく、非介入群で[PF][VT][MCS]が有意に増悪していた。SGRQは治療介入群で[Activity]と[Total]が有意に増悪し、非介入群では有意な変化は認めなかった。

Hepatotoxicity is a major immune-related adverse event that may become life-threatening. The impact of adding immune checkpoint blockade (ICB) to systemic therapy on the incidence of hepatotoxicity remains unknown. We performed a systematic review and meta-analysis to compare the incidence of hepatotoxicity among patients with cancer who received therapy with and without addition of ICB. PubMed, Embase, Web of Science, and Cochrane Library were searched to select phase 3 randomized controlled trials (RCTs) evaluating the effect of adding ICB to systemic therapy, placebo, or supportive care. The odds ratio (OR) of any grade and grade 3–5 hepatitis, elevations in aspartate aminotransferase (AST), and alanine aminotransferase (ALT) was pooled for meta-analysis. 43 RCTs with 28,905 participants were analyzed. Addition of ICB increased the incidence of hepatitis (any grade: OR, 2.13, 95% confidence interval [CI] 1.52–2.97, grade 3–5: OR, 2.66, 95% CI 1.72–4.11), elevated AST (any grade: OR, 2.16, 95% CI 1.73–2.70, grade 3–5: OR, 2.72, 95% CI 1.86–3.99), and elevated ALT (any grade: OR, 2.01, 95% CI 1.59–2.54, grade 3–5: OR, 2.40, 95% CI 1.62–3.55). Subgroup analysis based on the ICB mechanism revealed no significant heterogeneity among each mechanism for hepatitis (any Grade: I2 = 11.1%, p for heterogeneity = 0.32, grade 3–5: I2 = 0%, p = 0.48). Adding ICB to systemic therapy increases the incidence of hepatotoxicity regardless of the mechanism of ICB. Hepatotoxicity is common and vigilant monitoring of liver function is required during ICB therapy for patients with cancer.

Hepatotoxicity is a major immune-related adverse event that may become life-threatening. The impact of adding immune checkpoint blockade (ICB) to systemic therapy on the incidence of hepatotoxicity remains unknown. We performed a systematic review and meta-analysis to compare the incidence of hepatotoxicity among patients with cancer who received therapy with and without addition of ICB. PubMed, Embase, Web of Science, and Cochrane Library were searched to select phase 3 randomized controlled trials (RCTs) evaluating the effect of adding ICB to systemic therapy, placebo, or supportive care. The odds ratio (OR) of any grade and grade 3-5 hepatitis, elevations in aspartate aminotransferase (AST), and alanine aminotransferase (ALT) was pooled for meta-analysis. 43 RCTs with 28,905 participants were analyzed. Addition of ICB increased the incidence of hepatitis (any grade: OR, 2.13, 95% confidence interval [CI] 1.52-2.97, grade 3-5: OR, 2.66, 95% CI 1.72-4.11), elevated AST (any grade: OR, 2.16, 95% CI 1.73-2.70, grade 3-5: OR, 2.72, 95% CI 1.86-3.99), and elevated ALT (any grade: OR, 2.01, 95% CI 1.59-2.54, grade 3-5: OR, 2.40, 95% CI 1.62-3.55). Subgroup analysis based on the ICB mechanism revealed no significant heterogeneity among each mechanism for hepatitis (any Grade: I-2 = 11.1%, p for heterogeneity = 0.32, grade 3-5: I-2 = 0%, p = 0.48). Adding ICB to systemic therapy increases the incidence of hepatotoxicity regardless of the mechanism of ICB. Hepatotoxicity is common and vigilant monitoring of liver function is required during ICB therapy for patients with cancer.