癌症病人接受免疫治療之臨床評估與照護：以免疫相關皮膚不良事件為例

Clinical Assessment and Nursing Care of Patients with Cancer undergoing Immunotherapy: An Example for Immune-Related Cutaneous Adverse Events

詹瑞君(Jui-Chun Chan) ； 高子媗(Zi-Xuan, Gao) ； 陳璵帆(Yu-Fan Chen) ； 邱文姿(Wen-Tzu Chiu) ； 李芸湘(Yun-Hsiang Lee)

《腫瘤護理雜誌》 21卷2期 (2021/12) Pp. 21-34

https://doi.org/10.6880/TJON.202112_21(2).03

摘要

免疫檢查點抑制劑（Immune Checkpoint Inhibitors, ICIs，簡稱免疫藥物）已是癌症病人重要的癌症治療選項之一。目前台灣衛生福利部和美國FDA核准的免疫治療藥物包括抗PD-1（programmed celldeath-1）單株抗體的Pembrolizumab、 Nivolumab；抗PD-L1（programmed cell death ligand-1）單株抗體的Atezolizumab、Avelumab、Durvalumab和抗CTLA-4（cytotoxic T-lymphocyte -associated protein 4）單株抗體的Ipilimumab，這些藥物可控制疾病，進而延長病人的存活，但治療後最常發生且最早出現的免疫相關之皮膚不良事件（Immune-Related Cutaneous Adverse Events, ircAEs）也困擾病人，當病人ircAE嚴重度較高時，則需考量是否調整藥物劑量甚至停藥，如此將對病人疾病預後產生影響或對存活產生擔憂。現階段腫瘤照護文獻針對新興免疫治療所造成的ircAEs的認識、評估與照護仍相當有限，因此，本文將針對此部分進行完整之介紹，內容包括：（一）免疫治療與免疫相關皮膚不良事件介紹；（二）免疫相關皮膚不良事件評估與工具運用；（三）免疫相關皮膚不良事件治療與照護，期望透過本文能夠幫助臨床醫護人員學習免疫相關皮膚不良事件之臨床評估要點與照護。

關鍵字

癌症 ； 免疫檢查點抑制劑 ； 免疫相關皮膚不良事件

並列摘要

Immune checkpoint inhibitors (Immune Checkpoint Inhibitors, ICIs) are among the most important therapeutic options to date for oncology patients. Currently, the immunotherapy drugs approved by Taiwan's Ministry of Health and Welfare and by the United States' Food and Drug Administration (FDA) include Pembrolizumab and Nivolumab which target the programmed cell death-1 (PD-1); Atezolizumab, Avelumab, and Durvalumab which target the programmed cell death ligand-1 (PD-L1); and Ipilimumab targeting the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). All these drugs are monoclonal antibodies to improve disease control and prolong survival. However, it's accompanied with the immune-related cutaneous adverse events (ircAEs) as the most prevalent post-therapy side-effect. These events cause distress and affect the patients' quality of life. When a patient develops higher severity ircAEs prompting possible change or halt in the medicine dosage, the subsequent effects or survival becomes a concern. However, the literature remains limited on oncology care focusing on the understanding, evaluation, and nursing care for immunotherapy induced ircAEs. Therefore, this article aims to offer a complete introduction to this topic. The contents include: (i) the introduction to immunotherapy and ircAEs; (ii) the evaluation of ircAEs and the utilization of tools; (iii) the nursing care plan and management of ircAEs. We hope this could help clinical healthcare providers grasp the key points related to clinical assessment and nursing care plan of ircAEs.

並列關鍵字

cancer ； immune checkpoint inhibitors ； immune-related cutaneous adverse events

參考文獻

詹瑞君、廖幼婕、李芸湘、賴裕和（2014）．接受標靶治療的肺癌病患身體心像改變之臨床照護．護理雜誌，61（4），90-96。https://doi.org/10.6224/JN.61.4.90

Liu, J., Blake, S. J., Smyth, M. J., & Teng, M. W. (2014). Improved mouse models to assess tumour immunity and irAEs after combination cancer immunotherapies. Clinical & Trans-lational Immunology, 3(8), e22. https://doi.org/10.1038/cti.2014.18

Molassiotis, A., Uyterlinde, W., Hollen, P. J., Sarna, L., Palmer, P., & Krishnasamy, M. (2015). Supportive care in lung cancer: milestones over the past 40 years. Journal of Thoracic Oncology, 10(1), 10-18. https://doi.org/10.1097/JTO.0000000000000407

Muntyanu, A., Netchiporouk, E., Gerstein, W., Gniadecki, R., & Litvinov, I. V. (2021). Cutaneous immune-related adverse events (irAEs) to immune checkpoint inhibitors: a dermatology perspective on management. Journal of Cutaneous Medicine and Surgery, 25(1), 59-76. https://doi.org/10.1177/1203475420943260

Phillips, G. S., Wu, J., Hellmann, M. D., Postow, M. A., Rizvi, N. A., Freites-Martinez, A., Chan, D., Dusza, S., Motzer, R. J., Rosenberg, J. E., Callahan, M. K., Chapman, P. B., Geskin, L., Lopez, A. T., Reed, V. A., Fabbrocini, G., Annunziata, M. C., Kukoyi, O., Pabani, A., ... Lacouture, M. E. (2019). Treatment outcomes of immune-related cutaneous adverse events. Journal of Clinical Oncology, 37(30), 2746. https://doi.org/10.1200/JCO.18.02141