면역항암치료의 부작용 관리: 간과 위장관계를 중심으로

천재경 대한의사협회 2023 대한의사협회지 Vol.66 No.2

Background: Immunotherapy has become established as a new cancer treatment that enhances patients’ immune systems’ ability to fight cancer. Immune checkpoint inhibitors (ICI) have demonstrated remarkable benefits in the treatment of a range of cancer types. The increasing use of immune-based therapies has exposed a discrete group of immune-related adverse effects. Effective recognition and treatment of ICI-induced toxicities have emerged as essential goals of ICI management. Current Concepts: Gastrointestinal (GI) and hepatic adverse effects of ICI treatment are relatively common. Immune-related GI or hepatic toxicities occur in approximately 30% of patients. The incidence of grade 3 or 4 adverse effects ranges from 0.5% to 2%. The management strategy for immune-related adverse effects depends on their severity. In general, ICI treatment can be continued with close monitoring for mild (grade 1) GI/hepatic toxicities. ICI treatment should be interrupted for most grade 2 to 4 toxicities, and systemic steroid administration is recommended. If steroids are ineffective, immunosuppressive agents such as infliximab may be used. When symptoms and laboratory values revert to grade 1 or less, ICI treatment may be resumed with caution. Grade 4 toxicities warrant permanent discontinuation of ICI treatment. Discussion and Conclusion: Most immune-related GI and hepatic adverse effects are mild to moderate in severity and can be managed with supportive care, steroid therapy, and other immunomodulatory agents. Management of ICI-related toxicities in the GI and hepatic systems requires close collaboration between the patient, the treating oncologist, and other specialists.

의약분업 실시 전후 보건소 내소환자 진료내용 변화

천재경(Jae-Kyung Chun),감신(Sin Kam),한창현(Chang-Hyun Han) 한국농촌의학 지역보건학회 2002 농촌의학·지역보건 Vol.27 No.2

ARID1A Mutation from Targeted NGS Predicts Primary Resistance to Gemcitabine and Cisplatin Chemotherapy in Advanced Biliary Tract Cancer

이성환,천재경,이서영,강버들,김찬,심효섭,박영년,정상훈,최성훈,최혜진,이충근,전홍재 대한암학회 2023 Cancer Research and Treatment Vol.55 No.4

Purpose There are clinical unmet needs in predicting therapeutic response and precise strategy for the patient with advanced biliary tract cancer (BTC). We aimed to identify genomic alterations predicting therapeutic response and resistance to gemcitabine and cisplatin (Gem/Cis)-based chemotherapy in advanced BTC. Materials and Methods Genomic analysis of advanced BTC multi-institutional cohorts was performed using targeted panel sequencing. Genomic alterations were analyzed integrating patients’ clinicopathologic data, including clinical outcomes of Gem/Cis-based therapy. Significance of genetic alterations was validated using clinical next-generation sequencing (NGS) cohorts from public repositories and drug sensitivity data from cancer cell lines. Results 193 BTC patients from three cancer centers were analyzed. Most frequent genomic alterations were TP53 (55.5%), KRAS (22.8%), ARID1A (10.4%) alterations, and ERBB2 amplification (9.8%). Among 177 patients with BTC receiving Gem/Cis-based chemotherapy, ARID1A alteration was the only independent predictive molecular marker of primary resistance showing disease progression for 1st-line chemotherapy in the multivariate regression model (odds ratio, 3.12; p=0.046). In addition, ARID1A alteration was significantly correlated with inferior progression-free survival on Gem/Cis-based chemotherapy in the overall patient population (p=0.033) and in patients with extrahepatic cholangiocarcinoma (CCA) (p=0.041). External validation using public repository NGS revealed that ARID1A mutation was a significant predictor for poor survival in BTC patients. Investigation of multi-OMICs drug sensitivity data from cancer cell lines revealed that cisplatin-resistance was exclusively observed in ARID1A mutant bile duct cancer cells. Conclusion Integrative analysis with genomic alterations and clinical outcomes of the first-line Gem/Cis-based chemotherapy in advanced BTC revealed that patients with ARID1A alterations showed a significant worse clinical outcome, especially in extrahepatic CCA. Well-designed prospective studies are mandatory to validate the predictive role of ARID1A mutation.

Conventional Cisplatin-Based Combination Chemotherapy Is Effective in the Treatment of Metastatic Spermatocytic Seminoma with Extensive Rhabdomyosarcomatous Transformation

정유문,천재경,김태오,이선표,조영미,홍준혁,이재련 대한암학회 2015 Cancer Research and Treatment Vol.47 No.4

A 52-year-old man was presented with a huge left testicular mass and palpablecervical lymphadenopathy with retroperitoneal lymph node enlargement on anabdominal computed tomography. A left radical orchiectomy and an ultrasoundguidedneck node biopsy were performed. A pathological examination revealed spermatocyticseminoma with extensive rhabdomyosarcomatous transformation, acondition known to be highly resistant to platinum-based chemotherapy. The patientreceived four cycles of etoposide, ifosfamide and cisplatin (VIP) chemotherapy. Arepeat computed tomography revealed a substantial regression consistent with a partialresponse. Retroperitoneal lymph node dissection was attempted, which revealedrhabdomyosarcoma; however, complete microscopic resection was not achieved. After surgery, the residual abdominal lymph node progressed and salvage paclitaxel,ifosfamide and cisplatin (TIP) chemotherapy was employed, which again achieved apartial response. Here, we present a first case report of a spermatocytic seminomawith extensive rhabdomyosarcomatous transformation and multiple metastaticlymphadenopathies that showed a favorable response to platinum-based systemicchemotherapy.

호스피스 완화의료에서의 초기평가와 돌봄 계획의 수립: 평가도구를 중심으로

박은주,고수진,천재경,Park, Eun Ju,Koh, Su Jin,Cheon, Jae Kyung 한국호스피스완화의료학회 2019 한국호스피스.완화의료학회지 Vol.22 No.2

포괄적이고 총체적 돌봄을 제공하는 호스피스 완화의료의 경우 평가도구를 사용하여 문제목록의 객관화하고 돌봄 계획의 구체화하는 것이 필요하다. 초기평가는 입원 당일 혹은 1일 이내에 환자의 증상과 사회적, 영적 문제, 완화의료에 대한 요구가 무엇인지 파악하며 개괄적인 돌봄의 방향을 설정하는 과정이다. 현재 병에 대한 인식과 예후를 파악하는 것부터 연명의료계획서 작성까지 함께 검토한다. 초기평가도구로는 간단하지만 포괄적으로 신체적, 정신적, 사회적, 영적 영역을 아우르는 13개의 간단한 질문으로 구성된 NEST를 추천한다. 초기평가에서 파악된 문제에 대하여 구체적인 평가도구들을 활용하여 돌봄 계획을 수립하며 입원 후 3일이내 시행하는 것이 좋다. 신체적 영역의 경우 기능상태를 포함하여 통증과 비 통증 증상, 삶의 질을 함께 파악할 수 있는 다증상 평가도구가 도움이 될 수 있다. 환자의 증상은 단독으로 의미를 가지는 것이 아니라 복합적인 상호작용으로 발생하며, 그에 따라 포괄적으로 접근해야 하기 때문이다. 정신심리적 영역은 심리적 고통과 불안, 우울을 평가한다. 사회적 영역의 평가는 의사결정, 사회경제적 환경 파악, 가족 평가 및 임종 준비의 단계로 이루어진다. 영적 평가 역시 중요한데 FACIT-Sp나 SHI를 사용할 수 있다. 평가도구를 활용하는 것은 환자의 고통을 경감시키고 삶의 질을 향상시킬 뿐 아니라 의료진이 체계적으로 훈련되는 방안이 될 수 있으며 그 과정 자체가 더 나은 돌봄 제공을 위한 발판이 될 수 있다. For hospice palliative care that provides comprehensive and general care, it is necessary to use assessment tools to objectively list issues and detail care plans. The initial assessment is a process of establishing an overall direction of care by identifying the patient's symptoms, social and spiritual issues and palliative care needs on the admission day or within one day of admission. This process is also used to identify the patients' and families' awareness of the illness, prognosis, treatment options and if the Physician Orders for Life-Sustaining Treatment (POLST) has been drafted. Consisting of 13 simple questions regarding the physical, mental, social, and spiritual domains, the Needs at the End-of-Life Screening Tool (NEST) is recommended as an initial assessment tool. Using specific assessment tools, a care plan is established for the issues identified in the initial assessment within three days of admission. A multidisciplinary assessment tool can be helpful in the physical domain. The psychosocial domain evaluates psychological distress, anxiety and depression. The social domain examines an ability to make decisions, understanding of the socioeconomic circumstance, family relationship, and death preparedness. A spiritual evaluation is also important, for which the Functional Assessment of Chronic Illness Therapy-Spiritual WellBeing Scale (FACIT-Sp) or the Spiritual Health Inventory (SHI) can be used. The use of an assessment tool could not only contribute to pain mitigation a better quality of life for patients, but also provide systematic training for a multidisciplinary team; And the process itself could be a stepping stone for the better care provision.

박막 잔류응력 및 제조공정에 따른 금속박막층 미세크랙 영향

조병규,홍승찬,김병삼,천재경 대한금속·재료학회 2020 대한금속·재료학회지 Vol.58 No.3

In recent automobile trends, the functions of opening and closing the vehicle door are accomplished by touch sensor and smart-phone NFC (Near Field Communication) systems. These convenience features are incorporated into the outdoor handle. However, this function can’t be used when chrome plating is applied to this part for design purposes. To solve the problem of chrome plating, we studied a metal sputtering deposition process technology, which can preserve the metal feeling without interfering with NFC and touch sensor operation. To achieve this interface communication and sensing performance, we developed a surface treatment that can generate micro-cracks in the thin film layer. We also investigated how the door handle manufacturing process affected the shape of the micro-cracks in the thin film. Results showed that the thickness of the thin film and the target power played a crucial role in controlling the residual tensile stress in the thin film, which was one of major factors responsible for generating micro-cracks in the thin film layer. The shape of the micro-cracks in the thin film was affected by the adjacent layers of the thin film, the primer paint and UV top coat. The surface energy of the primer paint and the shear stress produced by the hardening of the UV top coat were found to affect the shape of the micro-cracks. In addition, we found that there was no change in the shape of the micro-cracks with additional heat treatment, if the residual tensile stress was sufficiently relieved by the micro-cracks formed in the thin film. The slits between the micro-cracks in the outdoor handle cover allowed the Capacitance Sensor and NFC to perform.

CaF2 저반사 코팅된 ZnS 윈도우의 8~12 µm 적외선 영역 광학적 특성

이일주,홍승찬,김병삼,천재경 대한금속·재료학회 2020 대한금속·재료학회지 Vol.58 No.6

Technologies for pedestrian safety are increasingly emphasized by Automakers in advance of autonomous driving vehicles. A Night Vision System attached behind the front grille can reduce fatal accidents, especially during the nighttime, however, consumers may hesitate to adopt such systems on account of their high price. High-cost Germanium is used in commercial Night Vision System windows, and therefore replacing it with a cheaper infrared window material can lead to a more affordable system. To achieve this, Zinc Sulfide (ZnS), which has about 70% transmittance in the Long-Wavelength Infrared region of 8~12 μm, was selected for the window substrate material. In this study, we designed, fabricated and characterized a single layer cost-effective anti-reflection coating on a ZnS window substrate using Calcium Fluoride (CaF2). The CaF2 coating was fabricated by E-beam evaporation technique, with Quarter wavelength anti-reflection thickness (QAR). It was characterized by FT-IR, SEM and a thermal camera test module. We found that CaF2 both side coated the ZnS window and exhibited about 10~15% higher transmittance than the ZnS window substrate. In addition the CaF2 coating stably bonded to the ZnS substrate without any internal defects. A thermal camera based window test also showed better detection performance with the CaF2 Coating than a bare ZnS substrate window, which was calculated using the output voltage of the microbolometer thermal sensor.

크론병에 동반된 속발성 아밀로이드증에서 infliximab 치료

송민주 ( Min Joo Song ),김효상 ( Hyo Sang Kim ),박소영 ( So Young Park ),천재경 ( Jae Kyung Cheon ),박소정 ( So Jung Park ),양지영 ( Ji Young Yang ),박수길 ( Su Kil Park ) 영남대학교 의과대학 2015 Yeungnam University Journal of Medicine Vol.32 No.2

Secondary systemic (AA) amyloidosis is a severe complication of progressed Crohn disease (CD) characterized by the deposition of amyloid A in body organs and tissues. Various therapeutic approaches have been recommended, however there is still no effective treatment. Recently, several case reports have demonstrated the effects of anti-tumor necrosis factor-α therapy in patients with AA amyloidosis associated with CD. We report on a 35-year-old female patient with CD complicated by AA amyloidosis in the gastrointestinal tract and renal involvement, who was treated with infliximab. The infliximab therapy improved the gastrointestinal symptoms and decreased the serum creatinine.

Feasibility Study of Physician Orders for Life-Sustaining Treatment for Patients with Terminal Cancer

안호정,전현정,전상훈,정현애,안희경,이경희,김민호,김주희,천재경,김진실,고수진 대한암학회 2019 Cancer Research and Treatment Vol.51 No.4

Purpose Physician Orders for Life-Sustaining Treatment (POLST) form is a legal document for terminally ill patients to make medical decisions with physicians near the end-of-life. A multicenter prospective study was conducted to evaluate the feasibility of POLST administration in actual oncological practice. Materials and Methods Patients with terminal cancer, age  20 years, and capable of communicating were eligible. The primary endpoint was the completion rate of POLST. Data about physicians’ or patients’ barriers were also collected. Results From June to December 2017, 336 patients from seven hospitals were eligible. Median patient age was 66 years (range, 20 to 94 years); 52.7% were male; and 60.4% had poor performance status. Primary cancer sites were hepato-pancreato-biliary (26.2%), lung (23.2%), and gastrointestinal (19.9%). Expected survival duration was 10.6±7.3 weeks, with 41.2% receiving hospice care, 37.9% showing progression after cancer treatment, and the remaining patients were under active treatment (15.8%) or initially diagnosed with terminal cancer (5.1%). POLST forms were introduced to 60.1% of patients, and 31.3% signed the form. Physicians’ barriers were reluctance of family (49.7%), lack of rapport (44.8%), patients’ denial of prognosis (34.3%), lack of time (22.7%), guilty feelings (21.5%), and uncertainty about either prognosis (21.0%) or the right time to discuss POLST (16.6%). The patients’ barriers were the lack of knowledge/understanding of POLST (65.1%), emotional discomfort (63.5%), difficulty in decision-making (66.7%), or denial of prognosis (14.3%). Conclusion One-third of patients completed POLST forms, and various barriers were identified. To overcome such barriers, social engagement, education, and systematic support might be necessary.

결핵성 흉막염으로 오인된 악성중피종

양지영 ( Ji Young Yang ),송민주 ( Min Joo Song ),박소정 ( So Jung Park ),천재경 ( Jae Kyung Cheon ),유정완 ( Jung Wan Yoo ),최창민 ( Chang Min Choi ),김용희 ( Yong Hee Kim ) 영남대학교 의과대학 2015 Yeungnam University Journal of Medicine Vol.32 No.1

Malignant mesothelioma is a common, primary tumor that can invade pleura, and is associated with previous exposure to asbestos. However, it poses considerable difficulties regarding its diagnosis and treatment, and thus, accurate history taking with respect to exposure to asbestos, and radiologic and pathologic examinations are essential. In addition, the involvement of a multidisciplinary team is recommended in order to ensure prompt and appropriate management using a framework based on radiotherapy, chemotherapy, surgery, and symptom palliation with end-of-life care. Because lymphocyte-dominant, exudative pleural effusion can occur in malignant mesothelioma, adenosine deaminase values may be elevated, which could be mistaken for tuberculous pleurisy, and lead to an incorrect diagnosis and suboptimal treatment. The authors describe a case of malignant mesothelioma initially misdiagnosed as tuberculous pleurisy. As evidenced by the described case, malignant mesothelioma should be considered during the differential diagnosis of patients with lymphocyte-dominant, exudative pleural effusion with a pleural lung lesion.