Kreamer Kristen M
Fox Chase Cancer Center, Philadelphia, Pennsylvania.
J Adv Pract Oncol. 2014 Nov-Dec;5(6):418-31. doi: 10.6004/jadpro.2014.5.6.3.
The approval of the immune checkpoint inhibitor ipilimumab for the treatment of advanced melanoma in 2011 spearheaded the development of other anticancer therapies with immune mechanisms of action, including other immune checkpoint inhibitors. Instead of acting directly on the tumor, these therapies work to "remove the brakes" on the immune system to restore antitumor immune responses. In addition to ipilimumab, which targets the cytotoxic T lymphocyte-associated antigen 4 pathway, several new drugs that target the programmed death-1 pathway are in phase III trials across tumor types, including melanoma, lung cancer, and renal cell carcinoma. In keeping with their unique mechanism of action, these immune checkpoint inhibitors have shown both conventional and unconventional response patterns, including initial apparent tumor progression followed by regression, and adverse events (AEs) that are likely immune-related. Advanced practitioners (APs) treating patients receiving immuno-oncology agents are in a key position to educate patients about expectations with these therapies and to screen patients for AEs and initiate appropriate and timely interventions. This review summarizes current immune checkpoint inhibitor data and provides patient management strategies for APs to optimize patient outcomes with these novel therapies.
2011年，免疫检查点抑制剂伊匹单抗被批准用于治疗晚期黑色素瘤，这推动了其他具有免疫作用机制的抗癌疗法的发展，包括其他免疫检查点抑制剂。这些疗法并非直接作用于肿瘤，而是致力于“解除”免疫系统的“刹车”，以恢复抗肿瘤免疫反应。除了靶向细胞毒性T淋巴细胞相关抗原4通路的伊匹单抗外，几种靶向程序性死亡-1通路的新药正在针对多种肿瘤类型进行III期试验，包括黑色素瘤、肺癌和肾细胞癌。鉴于其独特的作用机制，这些免疫检查点抑制剂呈现出传统和非传统的反应模式，包括最初明显的肿瘤进展随后消退，以及可能与免疫相关的不良事件（AE）。治疗接受免疫肿瘤药物治疗患者的高级从业者（AP）处于关键位置，要让患者了解这些疗法的预期效果，筛查患者的AE，并启动适当及时的干预措施。本综述总结了当前免疫检查点抑制剂的数据，并为AP提供患者管理策略，以通过这些新型疗法优化患者预后。
