非小細胞肺癌病人使用Anti-PD-1與Anti-PD-L1 抗體治療之比較

PD-1 Versus PD-L1 Inhibitors in Non-Small Cell Lung Cancer

10.6314/JIMT.201808_29(4).02

郭家佑(Chia-Yu Kuo)；洪仁宇(Jen-Yu Hung)

非小細胞肺癌(Non-small cell lung cancer) ； 抗細胞程式死亡受體-1 (Anti- Programmed cell death protein 1) ； 抗細胞死亡配體-1 (Programmed death-ligand 1)

內科學誌

29卷4期（2018 / 08 / 01）

210 - 216

繁體中文

非小細胞肺癌占了所有肺癌80%，是世界上最常見的惡性腫瘤之一。在早期，化學治療是末期肺癌的唯一治療選擇，直到第一線上皮細胞生長因素受體酪胺酸酶抑制劑（EGFR TKI）的標靶藥物問世，這樣的狀況因而改變。免疫治療則是近年來的熱門話題，免疫檢查點抑制劑（check point inhibitor）是目前證實可以有效控制晚期非小細胞肺癌病情發展的治療方式，藉由抑制PD-1或PD-L1來調控T淋巴細胞的功能，以造成癌細胞的凋亡。Nivolumab和Pembrolizumab是對抗PD-1之單株抗體，Atezolizumab則是對抗PD-L1的單株抗體。在療效上，抗PD-1與抗PD-L1的單株抗體在無惡化存活期與反應率差異並不大。在一般副作用方面，兩種單株抗體並無明顯差異。根據近期的研究，在免疫相關副作用上，相較抗PD-L1單株抗體，抗PD-1單株抗體有相對稍高的肺炎與甲狀腺炎/甲狀腺機能低下的發生率，但差異並不顯著。如發生免疫相關副作用，類固醇是標準的第一線治療。使用時間長度與何時重啟免疫治療則有賴臨床醫師視病人情況判斷。

Non-small-cell lung cancer (NSCLC), accounts for 80% of lung cancer, is one of the most common carcinoma in the world. Chemotherapy was the preferred option for advanced NSCLC before, until the first epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) was used for cancer therapy. Immunotherapy is a popular topic in recent years, and immune check point blockade is proven effective immunotherapy in NSCLC, which adjusts the function of T lymphocyte by blocking PD-1 or PD-L1 and induces the tumor cell apoptosis. Nivolumab and Pembrolizumab are monoclonal antibody for PD-1, and Atezolizumab is monoclonal antibody for PD-L1. In the treatment efficacy in recent study, anti-PD-1 and anti-PD-L1 monoclonal antibody had no significant difference in progression free survival and response rate. In general adverse effect, there was no significant difference in two types of monoclonal antibody. However, in immune-related adverse events (IRAE), compared to anti-PD-L1 monoclonal antibody, anti-PD-1 antibody had higher incidence rate for pneumonitis and thyroiditis / hypothyroidism, but the difference is not very significant. If the patients encountered IRAE, corticosteroid was the first line standard therapy. The usage of duration of corticosteroid and the timing to re-start immunotherapy are dependent on the judgement of the doctor and according to the condition of the patient.