淺談癌症免疫治療

Overview of Cancer Immunotherapy

10.3966/168395442018061801001

林玉芬(Yu-Fen Lin)；鄭吉元(Chi-Yuan Cheng)；王昭慧(Chao-Hui Wang)；張文震(John Wen-Cheng Chang)；陳麗娟(Li-Chuan Chen)；李淑慧(Shu-Hui Lee)

癌症 ； 免疫治療 ； 免疫檢查點抑制劑 ； cancer ； immunotherapy ； immune checkpoint inhibitors

腫瘤護理雜誌

18卷1期（2018 / 06 / 01）

5 - 11

繁體中文

癌症治療由手術、化學治療、放射線治療開始，進展到現今的免疫治療，給病患帶來一線生機。免疫檢查點抑制劑是目前發展用來恢復T細胞活化及加強抗癌的免疫反應藥物，目前經衛生署核可之藥物有CTLA-4抑制劑（Ipiimumab）、PD-1抑制劑（Pembrolizumab、Nivolumab）及PD-L1抑制劑（Atezolizumab）。然而人類的自體免疫系統能抗癌，但也會因為過度活化而造成自體的傷害，因而可能產生許多免疫相關的不良反應。免疫相關的不良反應可能發生在任一組織系統，大多發生於開始治療後數週到三個月之間。其中，最常見為皮膚方面不良反應，再者有內分泌系統、肝臟、腸胃道、肺臟、腎臟等等。針對各個系統的免疫相關不良反應，在醫療處置上與傳統症狀治療用藥極不相同，需透過正確評估症狀及診斷，經由專業的醫療團隊合作服務，提供詳盡的護理衛教，並即時使用類固醇藥物，方能守護病患的治療安全。

In the past, Cancer treatment started with surgery, followed by chemotherapy and then radiotherapy. Development of the lastest cancer immunotherapy brings a new chance of survival to patients. Immune checkpoint inhibitors (ICIs) are a kind of immunotherapy that recovers the activity of T cells and enhances anti-cancer ability. The Taiwan Food and Drug Administration has so far approved the use of ipilimumab (anti-CTLA4), pembrolizumab and nivolumab (anti- PD1), and atezolizumab (anti-PD-L1). However, there can be some immune-related adverse events (irAEs) caused by overactive autoimmune-induced injuries. The irAEs may involve any organ system and often appear from several weeks to 3 months after start of treatment. The most common irAE is dermatitis, followed by endocriopathy, hepatitis, enterocolitis, pneumonitis and nephritis. The treatment for these irAEs is very different from traditional symptomatic control. For patient safety during therapy, we need to carefully evaluate the clinical symptoms/ signs, make the correct diagnosis through professional medical multidisciplinary teams, provide detailed nursing education, and properly prescribe steroids.

1. Buchbinder, E. I.,Desai, A.(2016).CTLA-4 and PD-1 pathways: Simil-arities, differences, and implications of their inhibition.American Journal of Clinical Oncology,39(1),98-106.
2. Davies, M.,Duffieeld, E. A.(2017).Safety of chackpoint inhibitors for cancer treatment strategies for patient monitoring and management of immune-mediated adverse events.Immuno Targets and Therapy,6,51-71.
3. Gordon, R.,Kasler, M. K.,Stasi, K.,Shames, Y.,Errante, M.,Ciccolini, K.,Fischer-Cartlidge, E.(2017).Checkpoint inhibitors common immune-related adverse events and their management.Clinical Journal of Oncology Nursing,21,45-52.
4. Haanen, J.,Carbonnel, F.,Robert, C.,Kerr, K. M.,Peters, S.,Larkin, J.,Committee, E. G.(2017).Management of toxicities from immuno-therapy: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.Annals of Oncology,28,iv119-iv142.
5. Hahn, A. W.,Gill, D. M.,Agarwal, N.,Maughan, B. L.(2017).PD-1 Checkpoint inhibiton: Toxicities and management.Urologic Oncology: Seminars and Original Investigations,35(12),701-707.
6. Leung, J.,Suh, W., K.(2014).The CD28-B7 family in anti-tumor immunity: Emerging concepts in cancer immunotherapy.Immune Network,14(6),265-276.
7. Ott, P. A.,Hodi, F. S.,Robert, C.(2013).CTLA-4 and PD-1/PD-L1 blockade: New immunotherapeutic modalities with durable clinical benefit in melanoma patients.Clincal Cancer esearch,19(19),5300-5309.
8. Rubin, K.(2017).Advances in melanoma: The rationale for the melanoma nursing initiative.Clinical Journal of Oncology Nursing,21(4),7-10.
9. Schadendorf, D.,Hodi, F. S.,Robert, C.,Weber, J. S.,Margolin, K.,Hamid, d, O,Wolchok, J. D.(2015).Pooled analysis of long-term survival data from phase II and phase III trials of ipilimu-mab in unresectable or metastatic melanoma.Journal of Clinical Oncology,33(17),1889-1894.
10. Spain, L.,Diem, S.,Larkin, J.(2016).Management of toxicities of immune checkpoint inhibitors.Cancer Treatment Reviews,44,51-60.
11. 張錦明,張金堅(2014)。從第一屆唐獎生技醫藥獎談癌症免疫治療的展望。台灣醫界，57(9)，17-22。
12. 許育瑋(2017)。癌症治療的新趨勢─免疫治療。嘉基藥訊，127，1-3。
13. 郭弘揚,施金元,廖唯昱,余忠仁(2014)。免疫核對點抑制劑在非小細胞肺癌的治療。台灣醫界，18(6)，681-687。
14. 陳韻之,王裕仁(2017)。臨床併用放射線治療與免疫治療之進展。台北市醫師公會會刊，61(4)，34-39。
15. 彭偉倫(2016)。癌症免疫治療。當代醫藥法規月刊，74，1-10。
16. 楊景堯(2016)。肺癌免疫治療的新進展。台北市醫師公會會刊，60(9)，16-19。
17. 衛生福利部（2017年，11月6日）．民國105年死因統計年報電子書．取自https://dep.mohw.gov.tw/DOS/lp-3352-113.html
18. 衛生福利部食品藥物管理署（2018年，1月28日）．西藥、醫療器材、化妝品許可證查詢．取自https://www.fda.gov.tw/TC/site.aspx?sid=38
19. 鄭吉元,蔡慈貞,張文震(2017)。癌症免疫治療：癌症治療新紀元。藥學雜誌，33(4)，35-39。

1. 曾斐祺(2020)。大腸直腸癌的治療與照護。腫瘤護理雜誌，20(2)，5-9。
2. 謝春金,賴青青,張維允(2023)。一位肺癌個案初次接受免疫治療之護理經驗。腫瘤護理雜誌，23(1)，69-79。