, Après une suspension de l'immunothérapie, la reprise doit se faire à un grade de toxicité inférieur, après évaluation du rapport bénéfice-risque et après la fin du traitement par corticoïdes ou lorsque la posologie en corticoïde est très faible

É. Dans-notre, tous les traitements suspendus ont été repris à des grades inférieurs : 30, p.4

. Au-sein-de-notre-Étude, deux types d'associations d'immunothérapies ont été observées : l'association Nivolumab-Ipilimumab dans le mélanome et l'association Nivolumab

, ? Association Nivolumab-ipilimumab

, D'après les données de la littérature, l'association Nivolumab-Ipilimumab est décrite comme augmentant l'incidence des EI par rapport à une monothérapie 151

É. Dans-notre, 2 patients ont reçu l'association Nivolumab-Ipilimumab et ont développé des toxicités de grade 4 (respectivement une colite avec choc hémorragique et une cholestase)

, Selon les données des RCP, des cas de troubles digestifs et hépatiques de grade 4 sont décrits avec cette association d'immunothérapies

, Nos données sont insuffisantes pour se comparer à la littérature. ? Association Nivolumab-Brentuximab

. Au-sein-de-notre-cohorte, 1 patient a développé une toxicité grave avec l'association Nivolumab-Brentuximab. Ce patient a développé une fièvre (non neutropénique) et une cytolyse, le tout de grade 3. Ces effets sont décrits respectivement dans le RCP du Brentuximab comme très fréquent et fréquent

, Il nous est apparu intéressant d'établir un lien entre les comorbidités et l'apparition des toxicités

, Les patients ayant développé des exacerbations de psoriasis avaient du psoriasis en antécédent, les patients avec une toxicité cardiaque avaient des antécédents d'ordres cardiologiques (HTA, AOMI, rétrécissement aortique), le patient qui a présenté un déséquilibre du diabète avait un diabète de type 2 et un des patients qui a développé une pneumopathie interstitielle, Les liens que nous avons pu mettre en évidence au cours de notre étude ont été

, Ces données rejoignent en partie celles de la littérature : en effet, la plupart des cas de psoriasis

, Cependant, pour les toxicités cardiaque et pulmonaire nous n'avons pas retrouvé de données dans la littérature sur les facteurs prédictifs d'apparition

, De plus, pour toutes les autres toxicités de notre étude (digestive, hépatique, articulaire, rénale et anomalies biologiques), nous n'avons pas pu établir de liens

, En effets, ils permettraient d'anticiper l'apparition des toxicités graves des immunothérapies et d'améliorer la prise en charge. Cependant Il y a peu de données à ce sujet dans la littérature, Cette partie soulève l'intérêt de la connaissance des facteurs prédictifs des toxicités

, Le nombre total de patients inclus dans notre étude était de 418 dont 50 (soit 12%) ont développé une toxicité de grade 3-4. Dans les RCP, le nombre de patients inclus était beaucoup plus élevé

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