PO.CL11.01 · 临床研究
癌症免疫治疗中的脱发：单克隆抗体和抗体-药物偶联物的发病率和模式
Alopecia in cancer immunotherapy: Incidence and patterns with monoclonal antibodies and antibody-drug conjugates
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
肿瘤学的治疗格局正在演变，趋向于更具靶向性的方法，包括生物免疫调节剂。这些药物旨在最大限度地减少全身毒性，并提供比传统化疗更高的精确度，但它们并非没有不良反应。新出现的数据表明，生物疗法（如抗体-药物偶联物、免疫检查点抑制剂和干扰素）可能诱发癌症患者脱发。我们使用PubMed和Embase进行了范围综述，以识别报告接受生物疗法的癌症患者脱发情况的临床研究。合格的药物包括单克隆抗体，如抗体-药物偶联物（如trastuzumab deruxtecan）、免疫检查点抑制剂（如anti-PD-1、anti-PD-L1、anti-CTLA-4）和细胞因子靶向生物制剂（如干扰素、anti-IL疗法）。排除病例报告、临床前研究和综述。跨抗体类别对脱发发病率、严重程度和临床表现的数据进行定性综合。九项临床试验符合纳入标准，涵盖1,924例患者。抗体-药物偶联物（ADC），包括datopotamab deruxtecan、trastuzumab deruxtecan、tisotumab vedotin、enfortumab vedotin和disitamab vedotin，显示出最高的脱发发生率，范围为37%至56%（主要为1-2级）。这些递送拓扑异构酶I或微管抑制剂的ADC，用于患有乳腺癌、宫颈癌、尿路上皮癌、非小细胞肺癌和其他实体瘤的患者。相比之下，免疫检查点抑制剂如cemiplimab（anti-PD-1）和trastuzumab（anti-HER2）分别在肺癌和乳腺癌患者中很少与脱发相关（1-2.2%发病率，1-2级）。干扰素alfa-2b（一种I型干扰素受体激动剂）显示出时间依赖性效应，接受一个月治疗的黑色素瘤患者中报告脱发（1-3级）为9%，而接受一年方案者为28%。ADC所观察到的较高脱发发生率，可能反映了其所递送的化疗有效载荷的作用，而非抗体本身。相比之下，仅抗体疗法和干扰素疗法显示出显著更低的发生率（1-28%）。认识这些跨生物制剂类别的趋势，可帮助临床医生设定患者预期、指导咨询，并为在整个治疗过程中经历脱发的患者实施支持性措施。
查看英文原文 English abstract
The treatment landscape in oncology is evolving, with a shift toward more targeted approaches, including biologic immunomodulators. These agents are designed to minimize systemic toxicity and offer greater precision than traditional chemotherapy, yet they are not without adverse effects. Emerging data suggests that biologic therapies, such as antibody-drug conjugates, immune checkpoint inhibitors, and interferons, may induce alopecia in cancer patients. A scoping review was conducted using PubMed and Embase to identify clinical studies reporting alopecia in cancer patients treated with biologic therapies. Eligible agents included monoclonal antibodies such as antibody-drug conjugates (e.g., trastuzumab deruxtecan), immune checkpoint inhibitors (e.g., anti-PD-1, anti-PD-L1, anti-CTLA-4) and cytokine-targeting biologics (e.g., interferons, anti-IL therapies). Case reports, preclinical studies, and reviews were excluded. Data on alopecia incidence, severity, and clinical presentation were qualitatively synthesized across antibody classes. Nine clinical trials met inclusion criteria, encompassing 1,924 patients. Antibody-drug conjugates (ADCs), including datopotamab deruxtecan, trastuzumab deruxtecan, tisotumab vedotin, enfortumab vedotin, and disitamab vedotin, showed the highest rates of alopecia, ranging from 37% to 56% (predominantly grade 1-2). These ADCs, which delivered topoisomerase I or microtubule inhibitors, were used in patients with breast, cervical, urothelial, non-small cell lung cancer, and other solid tumors. In contrast, immune checkpoint inhibitors such as cemiplimab (anti-PD-1) and trastuzumab (anti-HER2) were rarely associated with alopecia (1-2.2% incidence, grade 1-2) in lung and breast cancer patients, respectively. Interferon alfa-2b, a type I interferon receptor agonist, demonstrated a time-dependent effect, with alopecia (grade 1-3) reported in 9% of melanoma patients receiving one month therapy versus 28% in those on one year regimens. The higher incidence of alopecia observed with ADCs likely reflects the effects of the chemotherapeutic payloads they deliver, rather than the antibody itself. In contrast, antibody-only and interferon therapies demonstrated substantially lower rates (1-28%). Recognizing these trends across biologic classes can help clinicians set patient expectations, guide counseling, and implement supportive measures for those experiencing hair loss throughout treatment.
利益披露 Disclosure
I. Kamholtz, None..
S. I. Gaumond, None.