HER2陽性轉移性乳癌治療新希望－－從護理的觀點談賀癌寧（trastuzumab emtansine）及其照護

New Hope for HER2-Positive Metastatic Breast Cancer Treatment: Trastuzumab Emtansine (T-DM1) From the Perspective of Nursing Care

第二型人類上皮細胞生長因子接受器（human epidermal growth factor receptor, HER2）陽性的乳癌病患，具較嚴重的疾病及較差的預後。對抗HER2的標靶藥物－賀癌平（trastuzumab）的發展，使得HER2陽性乳癌的病患存活率顯著提升。然而，轉移性HER2陽性的乳癌最終都將會發展出抗藥性。近年來，新的抗體與化學治療複合（anti body-drug conjugate）的藥物－賀癌寧（trastuzumab emtansine, T-DM1），可以改善抗藥性乳癌的治療成效。賀癌寧可能會出現的副作用有：血小板減少、肝功能指數升高、疲憊、心臟功能的影響、肺炎及周邊神經病變等。護理師必須瞭解此藥物的作用機制及副作用、給藥注意事項、評估副作用及處理方法，以確保病患安全，提升照護能力及護理品質。

Human epidermal growth factor receptor (HER2)-positive breast cancer is associated with a more aggressive disease and poor prognosis. The development of trastuzumab, a HER2-targeted agent, has changed the paradigm of HER2-positive breast cancer treatment and improved survival rates dramatically. However, metastatic HER2-positive breast cancer patients eventually develop resistance to this treatment regimen eventually. A new anti-HER2 antibody-drug conjugate, Trastuzumab emtansine (T-DM1), has been shown to improve treatment efficacy. However, side effects that differ from trastuzumab, including thrombocytopenia, liver dysfunction, fatigue, cardiotoxicity, pneumonitis, and peripheral neuropathy, may occur. Clinical nurses must understand the mechanism of this new agent and be aware of the symptoms and signs related to its side effects. Furthermore, clinical nurses should understand the varying degrees of these side effects, their probable causes, and the potential approaches to their management. Finally, clinical nurses must understand how to administer this agent in order to ensure patient safety. Understanding the side effects of T-DM1 and their management will help elevate nursing quality and caring efficacy.