Thrombotic events associated with immune checkpoint inhibitors and novel antithrombotic strategies to mitigate bleeding risk

IF 6.9 2区 医学 Q1 HEMATOLOGY Blood Reviews Pub Date : 2024-06-07 DOI:10.1016/j.blre.2024.101220
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Abstract

Although immunotherapy is expanding treatment options for cancer patients, the prognosis of advanced cancer remains poor, and these patients must contend with both cancers and cancer-related thrombotic events. In particular, immune checkpoint inhibitors are associated with an increased risk of atherosclerotic thrombotic events. Given the fundamental role of platelets in atherothrombosis, co-administration of antiplatelet agents is always indicated. Platelets are also involved in all steps of cancer progression. Classical antithrombotic drugs can cause inevitable hemorrhagic side effects due to blocking integrin β3 bidirectional signaling, which regulates simultaneously thrombosis and hemostasis. Meanwhile, many promising new targets are emerging with minimal bleeding risk and desirable anti-tumor effects. This review will focus on the issue of thrombosis during immune checkpoint inhibitor treatment and the role of platelet activation in cancer progression as well as explore the mechanisms by which novel antiplatelet therapies may exert both antithrombotic and antitumor effects without excessive bleeding risk.

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与免疫检查点抑制剂相关的血栓事件以及降低出血风险的新型抗血栓策略。
尽管免疫疗法正在扩大癌症患者的治疗选择,但晚期癌症的预后仍然很差,这些患者必须同时面对癌症和癌症相关的血栓事件。特别是,免疫检查点抑制剂与动脉粥样硬化血栓事件风险增加有关。鉴于血小板在动脉粥样硬化血栓形成中的重要作用,因此必须同时使用抗血小板药物。血小板也参与了癌症发展的各个阶段。传统的抗血栓药物会阻断整合素β3双向信号传导,从而导致不可避免的出血副作用,而整合素β3双向信号传导同时调节血栓形成和止血。与此同时,许多出血风险极低、抗肿瘤效果理想的新靶点正在出现。本综述将重点讨论免疫检查点抑制剂治疗过程中的血栓形成问题和血小板活化在癌症进展中的作用,并探讨新型抗血小板疗法可同时发挥抗血栓和抗肿瘤作用而不会有过度出血风险的机制。
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来源期刊
Blood Reviews
Blood Reviews 医学-血液学
CiteScore
13.80
自引率
1.40%
发文量
78
期刊介绍: Blood Reviews, a highly regarded international journal, serves as a vital information hub, offering comprehensive evaluations of clinical practices and research insights from esteemed experts. Specially commissioned, peer-reviewed articles authored by leading researchers and practitioners ensure extensive global coverage across all sub-specialties of hematology.
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