Thebeau Melissa, Rubin Krista, Hofmann Matthias, Grimm Julia, Weinstein Alyona, Choi Jennifer N
Moffitt Cancer Center, Tampa, Florida.
Bristol-Myers Squibb, Princeton, New Jersey.
J Am Assoc Nurse Pract. 2017 May;29(5):294-303. doi: 10.1002/2327-6924.12458. Epub 2017 Apr 24.
Immune checkpoint inhibitors are associated with a unique immune-related side effect profile that requires prompt recognition and management. Skin toxicities are the most common, and often earliest occurring, drug-related adverse events (AEs) of any grade observed upon treatment with these agents. The purpose of this review is to provide practical guidance on the identification and treatment of skin AEs associated with the immune checkpoint inhibitors (ipilimumab, nivolumab, and pembrolizumab) from a nursing perspective, and demonstrate hands-on application of the guidance using relevant patient case studies.
Data for drug-related skin AEs were summarized from phase 3 nivolumab and nivolumab + ipilimumab trials and phase 2 and 3 pembrolizumab trials. Patient case studies were provided by the lead (M.T.) and senior (J.N.C.) authors.
The recommendations presented here, based on accumulated clinical trial and clinical practice experience are consistent with established treatment guidelines and reach beyond established guidelines and recommendations for the management of AEs associated with immune checkpoint inhibitors.
The practical treatment guidance presented here may help familiarize medical teams with the recognition and management of skin AEs associated with these recently approved agents. The enclosed recommendations may contribute to optimized treatment through awareness of typical time to onset and clinical presentation, knowledge of management options, and appropriate application of treatment.
免疫检查点抑制剂与独特的免疫相关副作用谱相关，这需要及时识别和处理。皮肤毒性是使用这些药物治疗时观察到的任何级别的最常见且通常最早出现的药物相关不良事件（AE）。本综述的目的是从护理角度为与免疫检查点抑制剂（伊匹木单抗、纳武单抗和帕博利珠单抗）相关的皮肤AE的识别和治疗提供实用指导，并通过相关患者案例研究展示该指导的实际应用。
药物相关皮肤AE的数据总结自纳武单抗和纳武单抗+伊匹木单抗的3期试验以及帕博利珠单抗的2期和3期试验。患者案例研究由第一作者（M.T.）和资深作者（J.N.C.）提供。
基于积累的临床试验和临床实践经验提出的这些建议与既定的治疗指南一致，并且超出了与免疫检查点抑制剂相关AE管理的既定指南和建议。
这里提出的实用治疗指导可能有助于医疗团队熟悉与这些最近批准的药物相关的皮肤AE的识别和管理。随附的建议可能通过了解典型的发病时间和临床表现、管理选项知识以及治疗的适当应用，有助于优化治疗。
