探討免疫檢查點抑制劑治療轉移性泌尿道上皮癌

A Review of Immune Checkpoint Inhibitors for the Treatment of Metastatic Urothelial Carcinoma

10.6168/FJCP.201810_26(4).0002

鄭吉元(Chi-Yuan Cheng)；張文震(Wen-Cheng Chang)；蘇柏榮(Po-Jung Su)；蔡慈貞(Tzu-Cheng Tsai)

免疫檢查點抑制劑 ； 泌尿道上皮癌 ； Programmed Cell Death Protein 1 (PD-1) ； Programmed Cell Death Ligand 1 (PD-L1) ； Immune Checkpoint Inhibitor ； Urothelial Carcinoma ； Programmed Cell Death Protein 1 (PD-1) ； Programmed Cell Death Ligand 1 (PD-L1)

臺灣臨床藥學雜誌

26卷4期（2018 / 10 / 31）

258 - 265

繁體中文

轉移性泌尿道上皮癌(metastatic urothelial carcinoma, mUC)經第一線使用含鉑類(platinum)化療失敗後，後續治療藥物的效果並不理想。2016年5月至2017年5月，美國食品藥物管理局 (Food and Drug Administration, FDA)陸續核准5個免疫檢查點抑制劑(immune checkpoint inhibitors, ICIs)用於治療mUC，其藥物機轉是作用於programmed cell death protein 1 (PD-1)或programmed cell death ligand 1 (PD-L1)。這5個ICIs為atezolizumab、durvalumab、avelumab、nivolumab、pembrolizumab，它們皆被核准用於mUC第二線及其後線治療，其中atezolizumab和pembrolizumab亦核准可作為不適合以cisplatin為起始治療之mUC病人的第一線藥物。本文將總結這5個ICIs治療mUC的臨床試驗，檢視其療效和安全性，以及探討PD-L1表現百分比做為生物標記(biomarker)的限制。

The efficacy of subsequent systemic therapy in patients with metastatic urothelial carcinoma (mUC) is reduced after failure of first-line platinum-based chemotherapy. From May 2016 to May 2017, U.S. Food and Drug Administration (FDA) successively approved five immune checkpoint inhibitors (ICIs) of programmed cell death protein 1 (PD-1)/programmed cell death ligand 1 (PD-L1) blockade, including atezolizumab, durvalumab, avelumab, nivolumab, and pembrolizumab as second-line therapy and beyond for mUC treatment. The U.S. FDA also approved atezolizumab and pembrolizumab for first-line therapy in cisplatin-ineligible patients with mUC. This article summarizes the efficacy and safety of the five ICIs in the mUC clinical trials, and discuss the limitations of the PD-L1 expression as a biomarker.