Manejo en cuidado crítico de la toxicidad severa relacionada con la inmunoterapia en cáncer
DOI:
https://doi.org/10.56050/01205498.2307Resumen
En los últimos años, la inmunoterapia en oncología ha revolucionado el pronóstico de los pacientes con cáncer al dirigirse específicamente a las complejas interacciones entre las células tumorales y el huésped. Aunque estas terapias han mejorado significativamente las tasas de supervivencia, su aumento en uso ha llevado consigo la aparición de eventos adversos conocidos como irAEs. Estos incluyen una variedad de afecciones como alteraciones dermatológicas, endocrinas, gastrointestinales, el síndrome de liberación de citocinas (CRS), hipofisitis, neumonitis, miocarditis, meningitis y el síndrome de neurotoxicidad asociado a células efectoras inmunitarias (ICANS), así como las infecciones asociadas. En este artículo se describen detalladamente los irAEs más comunes, desde su epidemiología hasta su clasificación y diagnóstico, se exploran los posibles tratamientos para los casos más graves que requieren ingreso en unidades de cuidados intensivos (UCI), lo que incluye la suspensión de la inmunoterapia y medidas de soporte orgánico para ganar tiempo en eventos potencialmente reversibles. En la mayoría de las reacciones graves se utilizan corticosteroides y otras terapias inmunosupresoras para controlar la respuesta autoinmune. El conocimiento profundo de estos fenómenos de toxicidad es esencial para los médicos encargados del seguimiento de pacientes oncológicos, tanto en entornos ambulatorios como hospitalarios como para el personal asistencial de las unidades de cuidado intensivos, ya que la identificación temprana, el reporte adecuado y un manejo multidisciplinario pueden cambiar el curso de eventos potencialmente desfavorables. Este enfoque integral es fundamental para mejorar los desenlaces clínicos y la calidad de vida de los pacientes que se someten a inmunoterapia en el contexto oncológico.
Biografía del autor/a
Víctor Hugo Nieto Estrada, Centro de Tratamiento e Investigación sobre Cáncer (CTIC)
Unidad Funcional Asistencial Cuidado Intensivo, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC) / Grupo de investigación GIGA, Bogotá, Colombia
Daniel Molano Franco, Centro de Tratamiento e Investigación sobre Cáncer (CTIC)
Unidad Funcional Asistencial Cuidado Intensivo, Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo (CTIC) / Grupo de investigación GIGA, Bogotá, Colombia
Anacaona Martínez del Valle, Grupo GriBos, Bogotá
Departamento de Epidemiología, Grupo GriBos, Bogotá, Colombia
Carola Giménez-Esparza Vich, Sociedad Española de Medicina Intensiva
Médico Intensivista, Sociedad Española de Medicina Intensiva, Critica y Unidades Coronarias, Madrid, España.
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