Abstract:
BACKGROUND:Treatment with checkpoint inhibitors such as anti-programmed death-1 (anti-PD-1), anti-PD-ligand 1 (anti-PD-L1), and anti-cytotoxic T-lymphocyte antigen-4 (anti-CTLA-4) antibodies can prolong the survival of cancer patients, but it also induces autoimmune side effects in 86-96% of patients by activating the immune system. In 17-59% of patients, these are severe or even life-threatening. METHODS:This review is based on pertinent articles retrieved by a search in PubMed and on an evaluation of a side-effect registry. RESULTS:Checkpoint-inhibitor-induced autoimmune side effects manifest themselves in all organ systems, most commonly as skin lesions (46-62%), autoimmune colitis (22-48%), autoimmune hepatitis (7-33%), and endocrinopathies (thyroiditis, hypophysitis, adrenalitis, diabetes mellitus; 12-34%). Rarer side effects include pneumonitis (3-8%), nephritis (1-7%), cardiac side effects including cardiomyositis (5%), and neurological side effects (1-5%). Severe (sometimes lethal) side effects arise in 17-21%, 20-28%, and 59% of patients undergoing anti-PD-1 and anti- CTLA-4 antibody treatment and the approved combination therapy, respectively. With proper monitoring, however, these side effects can be recognized early and, usually, treated with success. Endocrine side effects generally require long-term hormone substitution. Patients who have stopped taking checkpoint inhibitors because of side effects do not show a poorer response of their melanoma or shorter survival in comparison to patients who continue to take checkpoint inhibitors. CONCLUSION:The complex management of checkpoint-inhibitor-induced side effects should be coordinated in experienced centers. The creation of an interdisciplinary "tox team" with designated experts for organ-specific side effects has proven useful. Prospective registry studies based on structured documentation of side effects in routine clinical practice are currently lacking and urgently needed.
journal_name
Dtsch Arztebl Intjournal_title
Deutsches Arzteblatt internationalauthors
Heinzerling L,de Toni EN,Schett G,Hundorfean G,Zimmer Ldoi
10.3238/arztebl.2019.0119subject
Has Abstractpub_date
2019-02-22 00:00:00pages
119-126issue
8issn
1866-0452pii
arztebl.2019.0119journal_volume
116pub_type
杂志文章,评审abstract:BACKGROUND:The treatment of pregnant women who have illnesses unrelated to pregnancy can cause uncertainty among physicians. METHODS:We searched the PubMed database and specialty guidelines from Germany and abroad (the guidelines of the German Society for Gynecology and Obstetrics, the American Congress of Obstetri ci...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2017.0616
更新日期:2017-09-15 00:00:00
abstract:BACKGROUND:Sunlight induces a wide variety of dermatoses. Their differential diagnosis is problematic not only because of similar phenotypes, but also because of confusing nomenclature and classification. METHODS:We selectively reviewed the literature of the past 20 years and describe the modern nosology of photoderma...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2011.0135
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:As life expectancies rise and the number of persons over age 75 in the population increases, the proper treatment of elderly cardiac patients is becoming a matter of ever greater medical and political importance. METHODS:In collaboration with the German Federal Quality Assurance Office (Bundesgeschäftsstell...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2009.0416
更新日期:2009-06-01 00:00:00
abstract:BACKGROUND:Breast cancer is the most common cancer in women. The German S3 guideline of 2012 has now been updated to take account of advances in the early detection, diagnostic evaluation, treatment, and follow-up care of this disease. METHODS:The updating process was based on the adaptation of identified source guide...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2018.0316
更新日期:2018-05-04 00:00:00
abstract:BACKGROUND:The randomized, controlled trial (RCT) is the gold standard of scientific evidence for the attribution of clinical effects (benefits and harms) to medical interventions. Many different designs for RCTs have been developed in order to counter legitimate critical objections and to better adapt the trials to th...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2017.0635
更新日期:2017-09-22 00:00:00
abstract:BACKGROUND:As of 1 April 2007, pharmacists in Germany filling prescriptions covered by the statutory health insurance system (Gesetzliche Krankenversicherung, GKV) are required, whenever possible, to dispense a preparation that contains the same active substance and for which a rebate contract is in effect. The physici...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2009.0783
更新日期:2009-11-01 00:00:00
abstract:BACKGROUND:When reading reports of medical research findings, one is usually confronted with p-values. Publications typically contain not just one p-value, but an abundance of them, mostly accompanied by the word "significant." This article is intended to help readers understand the problem of multiple p-values and how...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2010.0050
更新日期:2010-01-01 00:00:00
abstract:BACKGROUND:Surgical site infections (SSI) are among the most common healthcare- associated infections. The aim of our explorative study was to determine how selected climatic factors are associated with SSI rates. METHODS:SSI rates were calculated for operative procedures included in the surgi- cal site infection surv...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2019.0529
更新日期:2019-08-05 00:00:00
abstract:BACKGROUND:Dear Doctor Letters (also known as Direct Healthcare Professional Communications) inform physicians about significant newly discovered drug risks and about measures to take to reduce these risks. How far these warnings actually influence prescribing behavior is unclear. METHOD:The Geriatrics in Bavaria-Data...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2014.0255
更新日期:2014-04-11 00:00:00
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journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2011.0687
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:The incidence of sudden cardiac death in persons under age 40 is roughly 3 per 100 000 persons per year in Germany and North America. Many of these deaths are found to be due to hereditary heart diseases, often a primary structural heart disease associated with arrhythmia or else a primary arrhythmia syndrom...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2011.0623
更新日期:2011-09-01 00:00:00
abstract:INTRODUCTION:Intermittent paradoxical closure of the vocal cords can induce major attacks of dyspnea. Such attacks, called "vocal cord dysfunction" (VCD), are an important element in the differential diagnosis of intractable bronchial asthma. METHODS:Selective review of the literature. RESULTS:The etiology of VCD is ...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2008.0699
更新日期:2008-10-01 00:00:00
abstract:BACKGROUND:Atraumatic necrosis of the femoral head is a common cause of hip arthrosis in middle age. In Germany, it affects 5000-7000 patients per year, corresponding to an incidence of 0.01%. Though rarer than primary hip arthrosis, it is still of major clinical and socio-economic significance. Patients with this prob...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析,评审
doi:10.3238/arztebl.2016.0031
更新日期:2016-01-22 00:00:00
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journal_title:Deutsches Arzteblatt international
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doi:10.3238/arztebl.2015.0185
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journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,随机对照试验
doi:10.3238/arztebl.2016.0741
更新日期:2016-11-04 00:00:00
abstract:BACKGROUND:Red eye can arise as a manifestation of many different systemic and ophthalmological diseases. The physician whom the patient first consults for this problem is often not an ophthalmologist. A correct assessment of the urgency of the situation is vitally important for the planning of further diagnostic evalu...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2017.0302
更新日期:2017-04-28 00:00:00
abstract:BACKGROUND:The German Federal Law on Radiation Control contains no special provisions for X-ray studies in children and adolescents, even though exposure to ionizing radiation must be kept especially low in young persons, because their tissues are highly radiosensitive. Children, who have many years left to live, are m...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2011.0407
更新日期:2011-06-01 00:00:00
abstract:BACKGROUND:The German Standing Committee on Vaccination Recommendations (Ständige Impfkommission, STIKO) recommends standard vaccination against pneumococcal infections for all persons aged 60 or older, and for all persons of any age with an increased health risk. It is not known how many persons in the target group in...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2013.0743
更新日期:2013-11-01 00:00:00
abstract:INTRODUCTION:The choice of type of heart valve prosthesis is determined by the patient's age since bioprostheses have a limited lifespan. This article reviews current recommendations and the literature on cardiac valve replacement. METHODS:Selective literature search in Medline/PubMed back to 1996 and review of curren...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2008.0143
更新日期:2008-02-01 00:00:00
abstract:BACKGROUND:About 17% of all children suffer from a mental disorder in early childhood, defined as the period up to the age of 6 years. METHODS:This review is based on publications retrieved by a selective search in PubMed and the Web of Science, as well as on the authors' clinical and scientific experience. RESULTS:I...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2015.0375
更新日期:2015-05-25 00:00:00
abstract:BACKGROUND:Although the number of elderly patients with fractures is increasing, there have been only a few studies to date of the efficacy of collaborative treatment by trauma surgeons and geriatricians. METHODS:Data on patients over age 75 with femoral neck, trochanteric, proximal humeral, and pelvic ring fractures ...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2015.0113
更新日期:2015-02-13 00:00:00
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journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2012.0126
更新日期:2012-02-01 00:00:00
abstract:INTRODUCTION:Autopsy studies of persons who died of cancer have shown the lungs to be the sole site of metastasis in about 20% of cases. The resection of pulmonary metastases is indicated for palliative purposes if they contain a large volume of necrotic tumor, infiltrate the thoracic wall to produce pain, or cause hem...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2012.0645
更新日期:2012-10-01 00:00:00
abstract:BACKGROUND:Acne is the most common skin disease in adolescence, with a prevalence of nearly 100%. About 60% of affected adolescents have mild acne for which they use non-prescription preparations without consulting a physician. The remaining 40% constitute the population of acne patients seen in medical practice. The c...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2014.0301
更新日期:2014-04-25 00:00:00
abstract:BACKGROUND:Few reliable data are available on the epidemiology and treatment of spontaneous pneumothorax. We studied the sex and age distribution, frequency of hospitalization, mortality, and conservative versus surgical care of this condition in Germany in order to draw well-founded conclusions about its in-hospital d...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2017.0739
更新日期:2017-11-03 00:00:00
abstract:BACKGROUND:Systematic reviews provide a structured summary of the results of trials that have been carried out on any particular subject. If the data from multiple trials are sufficiently homogenous, a meta-analysis can be performed to calculate pooled effect estimates. Traditional meta-analysis involves groups of tria...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,meta分析,评审
doi:10.3238/arztebl.2015.0803
更新日期:2015-11-20 00:00:00
abstract:BACKGROUND:Psychiatric emergencies such as acute psychomotor agitation or suicidality often arise in non-psychiatric settings such as general hospitals, emergency services, or doctors' offices and give rise to stress for all persons involved. They may be life-threatening and must therefore be treated at once. In this a...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2011.0222
更新日期:2011-04-01 00:00:00
abstract:BACKGROUND:5% to 8% of 70-year-olds and some 10% of persons over age 80 have atrial fibrillation (AF). METHODS:Selective literature review. RESULTS:New scoring schemes (CHA(2)DS(2)-VASc score, HAS-BLED score) have been introduced to enable more accurate estimation of the risk of stroke and hemorrhage in patients with...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2012.0001
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:Dermatologists, paediatricians, and general practitioners are often consulted by worried parents for the evaluation of a cutaneous tumor. METHODS:Selective literature review. RESULTS:Only 1-2% of skin tumors excised in children turn out to be malignant when examined histologically. Warning signs of maligna...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章,评审
doi:10.3238/arztebl.2011.0347
更新日期:2011-05-01 00:00:00
abstract:BACKGROUND:Delirium is a common complication in elderly hospitalized patients. It prolongs the length of hospital stay, raises costs, increases the workload of the nursing staff, and may necessitate transfer of the patient to a nursing home. The risk of postoperative delirium is particularly high in elderly patients wi...
journal_title:Deutsches Arzteblatt international
pub_type: 杂志文章
doi:10.3238/arztebl.2015.0289
更新日期:2015-04-24 00:00:00