標靶治療藥品之皮膚毒性預防及照護指引

Clinical Practice Guideline: Prevention and Management of Targeted Therapy Related Skin Toxicities

張黎露(Li-Lu Chang) ； 朱家瑜(Chia-Yu Chu) ； 姜紹青(Shao-Chin Chiang) ； 許麗珠(Li-Chu Sheu) ； 黃國埕(Kuo-Cheng Huang) ； 周文珊(Wen-Shan Chou) ； 張美娟(Mei-Chuan Chang) ； 侯秀香(Hsiu-Hsiang Hou)

《腫瘤護理雜誌》 15卷增訂刊 (2015/12) Pp. 47-80

https://doi.org/10.3966/168395442015121503005

摘要

標靶治療藥品已經成為有效的癌症治療模式之一，相對於傳統的化療，標靶藥品雖可專一且直接地針對癌細胞生長途徑加以破壞以減少正常細胞傷害和降低治療的副作用，但根據臨床研究顯示，不同型態的標靶藥品治療，仍會伴隨不同程度的副作用，且與傳統細胞毒性藥品所引起的副作用型態完全不同。由於標靶藥品需要長期使用，有效預防與控制副作用是照護癌症病人的重要課題。本指引針對標靶治療引起的皮膚毒性包括丘疹膿疱疹、甲溝炎、毛髮改變、手足皮膚反應、皮膚乾燥、皮膚癢、皮膚龜裂和光敏感反應等進行系統性的文獻搜尋和評讀，同時彙整國內專家與未來指引使用者之意見，根據本國可用之醫療資源，最後形成可行之照護建議。本文可做為病人在接受標靶藥品治療引起之皮膚副作用之照護指引，幫助臨床專業人員的臨床決策，以提供病人最合適的照護。

關鍵字

標靶治療 ； 癌症病人 ； 皮膚毒性 ； 照護指引

並列摘要

Targeted therapy is well established as an effective treatment for cancers. Patients receiving certain types of targeted therapy, may develop varied type of dermatologic toxicities. Although these skin reactions are rarely severe, they often cause major discomfort that sometimes leads to treatment interruption. Prevention and management of target therapy-induced skin toxicities is crucial to ensure cancer patientʼs quality of life and treatment outcome. This guideline was developed based on systematic review of literature, appraisal of the evidences, and summary of recommendations for practice by expert committee. This guideline focuses on the following skin toxicities: papulopustular rash, paronychia, hair changes, hand-foot skin reaction, xerosis, pruritus, fissures, and photosensitivity. The guideline with comprehensive prevention and management recommendations are intended to assist the healthcare professionals in their decision-making for optimal quality of individualized patient care.

並列關鍵字

Targeted Therapy ； Cancer Patient ； Skin Toxicities ； Practice Guideline

參考文獻

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Lacouture, M. E., Reilly, L. M., Gerami, P. & Guitart, J. Hand foot skin reaction in cancer patients treated with the multikinase inhibitors sorafenib and sunitinib. Ann. Oncol. 19, 1955-1961. doi:10.1093/annonc/mdn389 (2008).

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Osio, A. et al. Cutaneous side-effects in patients on long-term treatment with epidermal growth factor receptor inhibitors. Br. J. Dermatol. 161, 515-521. doi:10.1111/j.1365-2133.2009.09214.x (2009).