Nivolumab喚醒免疫 抗癌&抗愛滋病毒???

研究發現抗癌藥Nivolumab可能成為HIV解藥 台灣英文新聞 2017/12/01（台灣英文新聞 / 高立寰 綜合外電報導）根據英國《衛報》，法國的一項研究發現，讓HIV（人類免疫缺乏病毒）患者服用用以對抗癌症的藥物Nivolumab，經過一段時間後，患者體內潛伏的HIV細胞大量減少，同時其CD8 「殺手」T細胞的活躍程度也大量提高。 受試病人已患有HIV超過20年，在接受實驗期間同時為肺癌進行治療，患者在癌症復發，並接受第一線化學藥物治療後，被給於抗癌藥物Nivolumab。 一段時間後，科學家發現患者體內的潛伏HIV細胞大量的減少，同時體內CD8 「殺手」T細胞的活性大幅提高。CD8 「殺手」T細胞是人體內免疫系統極重要的攻擊機制。主導此項研究的巴黎Pitié-Salpêtrière 教學醫院的Jean-Philippe Spano教授說：「這是此機制在人體成功進行的首次發現。這對於不管有癌症或沒有癌症的HIV患者來說都具有深刻的意義。因為它（Nivolumab）能夠在不影響其抗癌功用的情況下，同時大幅減少體內潛伏的HIV細胞。」根據長庚國際醫療中心的資訊，癌用新藥Nivolumab本身並不毒殺癌細胞或身體其他組織，而是藉由促進自體免疫反應、使自體免疫細胞攻擊癌細胞達到抗癌的效果。 研究指出，此藥物（Nivolumab）似乎有辦法可以「喚醒」體內受到HIV感染的白血球細胞，而當這些細胞活性被「喚醒」後，會開始製造HIV細胞，即會遭到免疫系統或是抗反轉錄病毒藥物（anti-retroviral therapy）鎖定並消滅。「越來越多研究者想要透過藥物才重新啟動這些潛伏並被HIV感染的細胞」Spano教授說道，「這樣將使免其能夠被免疫系統所看見並辨識，進而將其消滅。」如果體內的潛伏受感染細胞都能夠被消滅，HIV患者將有徹底痊癒的希望。然而，該領域的相關專家指出，面對這項發現還是必須謹慎為妙。倫敦衛生與熱帶醫學院（London School of Hygiene and Tropical Medicine）的藥物流行病學教授Stephen Evans指出，一項研究結果不能代表整體的效果。必須進行更多隨機的試驗與研究，才可以確認此項研究發現的可靠性。不過Evans也表示，此項研究確實指向消滅HIV方式的一種新的可能性。

Durable complete response to nivolumab in a patient with HIV and metastatic non-small cell lung cancer J Thorac Dis. 2017 Jun; 9(6): E540–E542. A 61-year-old male with a history of tobacco abuse and 8 years of well-controlled HIV (CD4 count of 684 and an undetectable viral load) on anti-retroviral therapy with emtricitabine-tenofovir and lopinavir-ritonavir initially presented with a right upper lobe mass. The patient underwent a CT-guided biopsy which showed poorly differentiated, squamous cell carcinoma of the lung. A PET scan demonstrated increased FDG avidity in the right upper lobe nodule, which was approximately 10 mm, as well in the ipsilateral mediastinal lymph nodes and subcarinal lymph nodes. Staging was completed with an endobronchial ultrasound (EBUS) with lymph node biopsy, and MRI of the brain. Patient was determined to be stage IIIa-T1a, N2, M0. He was initially treated with one cycle of carboplatin/paclitaxel while waiting radiation planning and then received definitive chemoradiation with cisplatin and etoposide and achieved an 80–90% response on CT in March of 2015. On 6-month follow-up scans he had developed new mediastinal lymphadenopathy which was biopsy confirmed recurrent NSCLC. Genomic profiling failed to demonstrate targetable lesions and radiation oncology did not feel that he was a candidate for further therapy. The patient was started on nivolumab in January 2016 and achieved a complete response (CR) on CT scan in March 2016, which was confirmed on repeat scans in June 2016. His experienced no side effects and his CD4 count remained stable and his viral load undetectable during and after treatment.