肿瘤患者免疫检查点抑制剂皮肤毒性管理智能体的构建与应用研究

doi:10.3761/j.issn.1672-9234.2026.08.015

Abstract

Abstract:

Objective To develop an intelligent agent for the management of immune checkpoint inhibitor-related skin toxicities in patients with cancer and evaluate its effectiveness in clinical practice. Methods A management checklist for immune checkpoint inhibitor-related skin toxicities in patients with cancer was developed through evidence synthesis，patient interviews，and expert panel discussions. Based on this checklist，an intelligent agent was constructed to support skin toxicity management. Using convenience sampling，146 patients with cancer receiving immune checkpoint inhibitor therapy who were admitted to the Department of Medical Oncology of a tertiary Grade A hospital in Zhejiang Province between January and June 2025 were enrolled. Participants were randomly assigned to either the intervention group or the control group using a random number table，with 73 patients in each group. Patients in the intervention group received intelligent agent-assisted management in addition to routine management provided to the control group. Skin toxicity self-management ability was assessed and compared between the two groups before the intervention and at days 7，14，and 28 of the intervention. Results There was a significant group-by-time interaction effect for skin toxicity self-management ability（F_interaction=201.08，P<0.001）. Simple effects analysis showed that self-management ability scores were significantly higher in the intervention group than in the control group at days 7，14，and 28 of the intervention（all P<0.001）. Conclusion The intelligent agent was developed through a rigorous process and aligned with clinical needs，providing digital support for continuous home-based management. It can improve the self-management ability of immune checkpoint inhibitor-related skin toxicities in patients with cancer.

Key words: Neoplasms, Immune Checkpoint Inhibitors, Skin Toxicity, Intelligent Agent, Nursing

ZHU Yanli, HONG Chaojin, FAN Shasha, SHEN Zhuqing, ZHAO Mengqin, XIE Lihai. Design and implementation of an intelligent agent for managing immune checkpoint inhibitor-related skin toxicities in cancer patients[J].Chinese Journal of Nursing Education, 2026, 23(8): 999-1007.

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References 35

[1]	杨智慧, 罗园园, 卢睿琦, 等. 肿瘤免疫检查点抑制剂相关皮肤毒性管理的证据总结[J]. 护理学杂志, 2024, 39(20):46-50.
	Yang ZH, Luo YY, Lu RQ, et al. Evidence-based summary of the management for immune checkpoint inhibitor-related cuta-neous toxicity[J]. J Nurs Sci, 2024, 39(20):46-50.
[2]	Martel J, Hanania HL, Patel AB. Immune checkpoint inhibitor-induced cutaneous toxicities:a review of histopathologic and clinical features[J]. Hum Pathol, 2023, 140:144-172. doi: 10.1016/j.humpath.2023.04.016
[3]	Nikolaou V, Tsimpidakis A, Stratigos A. Cutaneous adverse reactions of immunotherapy in patients with advanced melano-ma[J]. Cancers, 2023, 15(7):2084. doi: 10.3390/cancers15072084
[4]	牛志成, 王雷, 汪治宇. 免疫检查点抑制剂相关不良反应的管理专家共识[J]. 河北医科大学学报, 2021, 42(3):249-255.
	Niu ZC, Wang L, Wang ZY. Expert consensus on management of adverse reactions related to inhibitors at immune check-points[J]. J Hebei Med Univ, 2021, 42(3):249-255.
[5]	唐淑慧, 侯黎莉, 王汇. 非小细胞肺癌患者免疫治疗致皮肤毒性的调查研究[J]. 护理学杂志, 2020, 35(16):35-37.
	Tang SH, Hou LL, Wang H. Longitudinal study of skin toxicity caused by immunotherapy in patients with non-small cell lung cancer[J]. J Nurs Sci, 2020, 35(16):35-37.
[6]	张娜, 焦蕊蕊, 齐可华. 直肠癌免疫治疗皮肤毒性反应的循证护理效果[J]. 中国肛肠病杂志, 2023, 43(12):42-44.
	Zhang N, Jiao RR, Qi KH. Effect of evidence-based nursing on skin toxicity reaction in immunotherapy for rectal cancer[J]. Chin J Coloproctology, 2023, 43(12):42-44.
[7]	《肿瘤免疫检查点抑制剂引起皮肤不良反应多学科专家共识(2025版)》编写委员会. 肿瘤免疫检查点抑制剂引起皮肤不良反应多学科专家共识(2025版)[J]. 中国临床医学, 2025, 32(2):306-320.
	Expert Committee of Multi-disciplinary expert consensus on cutaneous adverse events caused by immune checkpoint inhi-bitors(2025). Multi-disciplinary expert consensus on cutaneous adverse events caused by immune checkpoint inhibitors(2025)[J]. Chin J Clin Med,2025, 32(2):306-320.
[8]	《食管癌患者免疫检查点抑制剂治疗相关不良反应的护理中国专家共识》编写组. 食管癌患者免疫检查点抑制剂治疗相关不良反应的护理中国专家共识[J]. 中华保健医学杂志, 2024, 26(1):5-9.
	Writing Group of the Chinese expert consensus on nursing for immune checkpoint inhibitor-related adverse events in esopha-geal cancer patients. Chinese expert consensus on nursing for immune checkpoint inhibitor-related adverse events in patients with esophageal cancer[J]. Chin J Health Care Med, 2024, 26(1):5-9.
[9]	《中国消化道肿瘤免疫治疗不良反应专家共识(2023年版)》编写组. 中国消化道肿瘤免疫治疗不良反应专家共识(2023年版)[J]. 肿瘤综合治疗电子杂志, 2023, 9(2):26-60.
	Compilation group of the consensus on immune-related adverse events of gastrointestinal tumors in China(2023 edition). Con-sensus on immune-related adverse events of gastrointestinal tumor in China(2023 edition)[J]. J Multidiscip Cancer Manag (Electron Vers), 2023, 9(2):26-60.
[10]	中国临床肿瘤学会免疫治疗专家委员会, 中国临床肿瘤学会抗肿瘤药物安全管理专家委员会. 免疫检查点抑制剂相关的毒性多学科诊疗协作组建设中国专家共识[J]. 临床肿瘤学杂志, 2022, 27(2):158-164.
	Chinese Society of Clinical Oncology(CSCO) Committee of Immunotherapy, CSCO Committee on the Safety Management of Antitumor Drugs. Chinese expert consensus on multidisci-plinary management of immune checkpoint inhibitor-related toxicities[J]. Chin Clin Oncol, 2022, 27(2):158-164.
[11]	Schneider BJ, Naidoo J, Santomasso BD, et al. Management of immune-related adverse events in patients treated with immu-ne checkpoint inhibitor therapy:ASCO guideline update[J]. J Clin Oncol, 2021, 39(36):4073-4126. doi: 10.1200/JCO.21.01440
[12]	Haanen J, Obeid M, Spain L, et al. Management of toxicities from immunotherapy:ESMO Clinical Practice Guideline for diagnosis,treatment and follow-up[J]. Ann Oncol, 2022, 33(12):1217-1238. doi: 10.1016/j.annonc.2022.10.001 pmid: 36270461
[13]	Zhang LY, Lu YH. Follow-up care for patients receiving im-mune checkpoint inhibitors[J]. Asia Pac J Oncol Nurs, 2021, 8(6):596-603. doi: 10.4103/apjon.apjon-2129
[14]	Barman H, Venkateswaran S, Santo AD, et al. Identification and characterization of immune checkpoint inhibitor-induced toxi-cities from electronic health records using natural language processing[J]. JCO Clin Cancer Inform, 2024, 8:e2300151.
[15]	Gupta S, Belouali A, Shah NJ, et al. Automated identification of patients with immune-related adverse events from clinical notes using word embedding and machine learning[J]. JCO Clin Cancer Inform, 2021, 5:541-549. doi: 10.1200/CCI.20.00109 pmid: 33989017
[16]	倪军, 黄淼, 张力, 等. 非小细胞肺癌围手术期免疫治疗相关不良反应管理的临床诊疗建议[J]. 中国肺癌杂志, 2021, 24(3):141-160.
	Ni J, Huang M, Zhang L, et al. Clinical recommendations for perioperative immunotherapy-induced adverse events in patients with non-small cell lung cancer[J]. Chin J Lung Cancer, 2021, 24(3):141-160.
[17]	施国明, 黄晓勇, 任正刚, 等. 肝癌免疫检查点抑制剂相关不良反应管理中国专家共识(2021版)[J]. 中华消化外科杂志, 2021, 20(12):1241-1258.
	Shi GM, Huang XY, Ren ZG, et al. Chinese expert consensus on the management of immune-related adverse events of hepatocellular carcinoma treated with immune checkpoint inhibitors(2021 edition)[J]. Chin J Dig Surg, 2021, 20(12):1241-1258.
[18]	国际肝胆胰协会中国分会, 中华医学会外科学分会肝脏外科学组, 中国临床肿瘤学会(CSCO)肝癌专家委员会. 基于免疫节点抑制剂的肝细胞癌免疫联合治疗多学科中国专家共识(2021版)[J]. 中华肝脏病杂志, 2021, 29(7):636-647.
	The Chinese Chapter of the International Hepato-Pancreato-Biliary Association; Group of Liver Surgery,Surgery Society of Chinese Medical Association; Expert Committee on Liver Cancer,Chinese Society of Clinical Oncology. Chinese multi-disciplinary expert consensus on combined immunotherapy based on immune checkpoint inhibitors for hepatocellular carcinoma(2021 version)[J]. Chin J Hepatol, 2021, 29(7):636-647.
[19]	中国临床肿瘤学会抗肿瘤药物安全管理专家委员会, 中国临床肿瘤学会免疫治疗专家委员会. 卡瑞利珠单抗致反应性皮肤毛细血管增生症临床诊治专家共识[J]. 临床肿瘤学杂志, 2020, 25(9):840-848.
	Chinese Society of Clinical Oncology(CSCO) Expert Commit-tee on Antitumor Drug Safety Management, CSCO Expert Com-mittee on Immunotherapy. Expert consensus on the clinical diagnosis and treatment of camrelizumab induced reactive cutaneous capillary endothelial proliferation[J]. Chin Clin Oncol, 2020, 25(9):840-848.
[20]	斯晓燕, 何春霞, 张丽, 等. 免疫检查点抑制剂相关皮肤不良反应诊治建议[J]. 中国肺癌杂志, 2019, 22(10):639-644.
	Si XY, He CX, Zhang L, et al. Management of dermatologic toxicities related to immune checkpoint inhibitors[J]. Chin J Lung Cancer, 2019, 22(10):639-644.
[21]	中华医学会皮肤性病学分会, 中国医师协会皮肤科医师分会, 中国老年医学学会皮肤医学分会, 等. 免疫检查点抑制剂相关皮肤不良反应诊治中国专家共识(2024版)[J]. 中华医学杂志, 2024, 104(20):1790-1803.
	Chinese Society Dermatology of the Chinese Medical Associa-tion, Chinese Dermatologist Association of the Chinese Medi-cal Doctor Association, Dermatology Division of the Chinese Geriatrics Society. Chinese expert consensus on diagnosis and treatment of immune checkpoint inhibitor-related skin adverse reactions(2024 edition)[J]. Natl Med J China, 2024, 104(20):1790-1803.
[22]	上海市医学会皮肤性病学分会, 上海市医学会肿瘤靶分子专科分会. 抗肿瘤药物相关皮肤不良反应管理专家共识[J]. 中华皮肤科杂志, 2023, 56(10):907-919.
	Shanghai Society of Dermatology and Venereology; Shanghai Society of Target Molecular Oncology,Shanghai Medical Asso-ciation. Consensus on the management of cutaneous adverse reactions to anti-tumor drugs[J]. Chin J Dermatol, 2023, 56(10):907-919.
[23]	中国临床肿瘤学会指南工作委员会. 中国临床肿瘤学会(CSCO)免疫检查点抑制剂临床应用指南-2024[M]. 北京: 人民卫生出版社, 2024.
	Guidelines Working Committee of Chinese Society of Clinical Oncology. Guidelines of Chinese Society of Clinical Oncology (CSCO) immune checkpoint inhibitor clinical practice[M]. Beijing: People’s Medical Publishing House, 2024.
[24]	中国医师协会呼吸医师分会, 中国医师协会肿瘤多学科诊疗专业委员会. 免疫检查点抑制剂相关毒性防治与管理建议[J]. 中华医学杂志, 2022, 102(24):1811-1832.
	Chinese Association of Chest Physicians; Multidisciplinary Team Diagnosis and Treatment Committee, Chinese Medical Doctor Association. Recommendations on the prevention,treat-ment and management of immune checkpoint inhibitor-associated toxicities[J]. Natl Med J China, 2022, 102(24):1811-1832.
[25]	Majem M, García-Martínez E, Martinez M, et al. SEOM clinical guideline for the management of immune-related adverse events in patients treated with immune checkpoint inhibitors(2019)[J]. Clin Transl Oncol, 2020, 22(2):213-222. doi: 10.1007/s12094-019-02273-x pmid: 31993963
[26]	Brahmer JR, Abu-Sbeih H, Ascierto PA, et al. Society for Im-munotherapy of Cancer(SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events[J]. J Immunother Cancer, 2021, 9(6):e002435. doi: 10.1136/jitc-2021-002435
[27]	O’Cearbhaill RE, Clark L, Eskander RN, et al. Immunotherapy toxicities:an SGO clinical practice statement[J]. Gynecol Oncol, 2022, 166(1):25-35. doi: 10.1016/j.ygyno.2022.05.003
[28]	Cury-Martins J, Eris APM, Abdalla CMZ, et al. Management of dermatologic adverse events from cancer therapies:recommen-dations of an expert panel[J]. Anais Brasileiros De Dermatol, 2020, 95(2):221-237. doi: 10.1016/j.abd.2020.01.001
[29]	Apalla Z, Nikolaou V, Fattore D, et al. European recommen-dations for management of immune checkpoint inhibitors-derived dermatologic adverse events. The EADV task force ‘Dermatology for cancer patients’ position statement[J]. J Eur Acad Dermatol Venereol, 2022, 36(3):332-350. doi: 10.1111/jdv.v36.3
[30]	Patel AB, Tattersall IW. Cutaneous immune-related adverse events associated with immune checkpoint inhibitors[EB/OL].[2026-01-07]. https://www.uptodate.com/contents/cutaneous-im-mune-related-adverse-events-associated-with-immune-checkpoint-inhibitors.
[31]	Shannon VR, Anderson R, Blidner A, et al. Multinational Asso-ciation of Supportive Care in Cancer(MASCC) 2020 clinical practice recommendations for the management of immune-related adverse events:pulmonary toxicity[J]. Support Care Cancer, 2020, 28(12):6145-6157.
[32]	Linder L. Analysis of the UCSF symptom management theory:implications for pediatric oncology nursing[J]. J Pediatr Oncol Nurs, 2010, 27(6):316-324. doi: 10.1177/1043454210368532 pmid: 20639345
[33]	王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
	Wang CQ, Hu Y. JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[34]	吕亚奇, 冯国双. 医学研究中常见的样本量估算方法[J]. 慢性病学杂志, 2016, 17(4):359-361.
	Lü YQ, Feng GS. Common methods of sample size estimation in medical research[J]. Chronic Pathematology J, 2016, 17(4):359-361.
[35]	郑金龙, 郑雪梅, 史君伟, 等. 肺癌病人免疫检查点抑制剂相关皮肤毒性护理方案的构建及应用[J]. 护理研究, 2025, 39(15):2535-2543.
	Zheng JL, Zheng XM, Shi JW, et al. Construction and applica-tion of nursing programme for immune checkpoint inhibitors-related skin toxicity in lung cancer patients[J]. Chin Nurs Res, 2025, 39(15):2535-2543.

Design and implementation of an intelligent agent for managing immune checkpoint inhibitor-related skin toxicities in cancer patients

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