免疫核對點抑制劑及其相關不良反應和處理

Managing the Adverse Effects Related to Immune Checkpoint Inhibitors

免疫核對點抑制劑為近年來癌症治療的新趨勢， 針對細胞毒性T淋巴細胞相關抗原-4（cytotoxic T– lymphocyte-associated antigen 4, CTLA-4）及程序性細胞死亡1（programmed cell death-1, PD-1） 核對點的抑制劑，如ipilimumab（Yervoy(R)，益伏）、pembrolizumab（Keytruda(R)， 吉舒達）和nivolumab（Opdivo(R)，保疾伏）被用來提升病患T 細胞的活性及毒殺腫瘤的能力，以達到抗癌的效果。這些藥物各有不同的使用建議劑量及調配方法必須注意，此外，這些免疫核對點抑制劑可能會引發皮膚、腸胃道、肝臟、內分泌、肺部及一些罕見但嚴重的免疫相關不良反應，臨床醫療護理人員必須熟悉早期徵象和評估及了解相關處理方式。

Immune checkpoint inhibitors (ICIs) have become the new posterchild of cancer treatment in recent years largely due to their impressive clinical efficacy. Drugs targeting cytotoxic T– lymphocyte-associated antigen 4 (CTLA-4) and programmed cell death-1 (PD-1) antibodies, e.g., ipilimumab (Yervoy(R)), pembrolizumab (Keytruda(R)), and nivolumab (Opdivo(R)) reinvigorate cytotoxic T cells to kill cancer cells in patients. Despite the impressive clinical benefits, ICIs may induce immune-related adverse events (irAE) of the skin, gastrointestinal tract, liver, endocrine, and lung with a wide spectrum of severity. Rare but severe irAEs of critical organs such as the heart and central nervous system have also been reported. Clinical practitioners must recognize the early signs and symptoms of irAE as well as related management strategies.