The enhancement of immune responses upon treatment with immune checkpoint inhibitors can have the desired outcome of reinvigorating antitumour immune surveillance, but often at the expense of immune-related adverse events (irAEs). This novel disease entity often prompts comparisons with, and extrapolation of treatment approaches from, primary autoimmune disorders. Accordingly, current treatment guidelines for irAEs make generic recommendations adapted from the literature describing primary autoimmune diseases, without taking into consideration the substantial disparity of the immunohistopathological findings within each organ affected by an irAE. The treatment modalities themselves are complex and have many potential drawbacks, such as serious and rarely fatal infections, drug toxicities overlapping with irAEs and the risk of compromising cancer immune surveillance. Herein, we provide an overview of key cellular and soluble immunological factors mediating irAEs and propose a model integrating this knowledge with the immunohistopathological findings of the affected organs for a personalized decision-making process for each patient.

接受免疫检查点抑制剂治疗后，增强免疫反应可以达到重新激发抗肿瘤免疫监测的预期效果，但通常以免疫相关的不良事件（irAE）为代价。这种新颖的疾病实体常常提示与原发性自身免疫性疾病进行比较，并从中推断出治疗方法。因此，当前针对irAE的治疗指南从描述原发性自身免疫疾病的文献中提出了通用建议，而没有考虑到受irAE影响的每个器官中免疫组织病理学发现的实质性差异。治疗方式本身很复杂，并具有许多潜在的缺点，例如严重且很少致命的感染，药物毒性与irAEs重叠以及危害癌症免疫监测的风险。在此，我们概述了介导irAE的关键细胞和可溶性免疫学因素，并提出了一个模型，将这一知识与受影响器官的免疫组织病理学发现相结合，以针对每个患者进行个性化的决策过程。