IMiD (Immunomodulatory Drug)
2025. 5. 16. 19:30
๋ฐ˜์‘ํ˜•

๐Ÿงฌ IMiD๋ž€?

ํ•ญ๋ชฉ์„ค๋ช…
์ „์ฒด ์ด๋ฆ„ Immunomodulatory imide Drug
๊ธฐ์› Thalidomide (1950~60๋…„๋Œ€) → ๋ฉด์—ญ ํ•ญ์•”์ œ๋กœ ์žฌ๋ฐœ๊ฒฌ
์ ์‘์ฆ - ๋‹ค๋ฐœ๊ณจ์ˆ˜์ข…(MM)
- ๊ณจ์ˆ˜ํ˜•์„ฑ์ด์ƒ์ฆํ›„๊ตฐ(MDS)
- ์ผ๋ถ€ ๋ฆผํ”„์ข…
๋Œ€ํ‘œ ์•ฝ๋ฌผ - Thalidomide
- Lenalidomide (Revlimid)
- Pomalidomide (Pomalyst)
 

โš™๏ธ ์ž‘์šฉ ๊ธฐ์ „

  1. CRBN (cereblon) ๊ฒฐํ•ฉ
    → ์œ ๋น„ํ€ดํ‹ด ํ”„๋กœํ…Œ์•„์ข€ ์‹œ์Šคํ…œ(Ubiquitin-Proteasome System) ํ™œ์„ฑํ™”
    → ํŠน์ • ์ „์‚ฌ์ธ์ž(Ikaros, Aiolos) ๋ถ„ํ•ด ์œ ๋„
  2. ๋ฉด์—ญ์ž‘์šฉ ๊ฐ•ํ™”
    • T cell / NK cell ํ™œ์„ฑ ↑
    • IL-2, IFN-γ ๋“ฑ ์‚ฌ์ดํ† ์นด์ธ ๋ถ„๋น„ ↑
    • ์ข…์–‘ ๋ฏธ์„ธํ™˜๊ฒฝ ๋‚ด ๋ฉด์—ญ์–ต์ œ ์–ต์ œ
  3. ํ•ญ์•” ์ง์ ‘ ํšจ๊ณผ
    • ์ข…์–‘์„ธํฌ ์„ฑ์žฅ ์–ต์ œ
    • ํ˜ˆ๊ด€์‹ ์ƒ ์–ต์ œ (anti-angiogenesis)

๐Ÿ’Š ์ฃผ์š” IMiD ์•ฝ๋ฌผ ๋น„๊ต

์•ฝ๋ฌผ๋ช…์ƒํ’ˆ๋ช…ํŠน์ง•์ ์‘์ฆ๋ณ‘์šฉ
Thalidomide Thalomid ์ดˆ๊ธฐ IMiD, ๋ง์ดˆ์‹ ๊ฒฝ๋ณ‘์ฆ ↑ MM DEX ๋ณ‘์šฉ
Lenalidomide Revlimid ๊ฐ€์žฅ ๋„๋ฆฌ ์‚ฌ์šฉ MM, MDS, NHL ๋“ฑ VRd, Rd
Pomalidomide Pomalyst Refractory MM ๋Œ€์‘ MM (ํ›„์†๋ผ์ธ) Pom + DEX
 

๐Ÿ“Š ์ž„์ƒ์—์„œ์˜ ์—ญํ• 

์ƒํ™ฉ์‚ฌ์šฉ ์˜ˆ
์ดˆ๊ธฐ ์น˜๋ฃŒ Lenalidomide + Bortezomib + Dexamethasone (VRd)
์œ ์ง€์š”๋ฒ• ์ž๊ฐ€์กฐํ˜ˆ๋ชจ์„ธํฌ์ด์‹ ํ›„ Lenalidomide ์œ ์ง€
์žฌ๋ฐœ/๋ถˆ์‘ MM Pomalidomide + DEX ± monoclonal Ab (ex: Dara-Pom-DEX)
 

โš ๏ธ ๋ถ€์ž‘์šฉ

์ข…๋ฅ˜์„ค๋ช…
๊ณจ์ˆ˜์–ต์ œ ๋นˆํ˜ˆ, ํ˜ธ์ค‘๊ตฌ๊ฐ์†Œ์ฆ
ํ˜ˆ์ „์ฆ DVT/PE ์œ„ํ—˜ → ํ•ญ์‘๊ณ ์ œ ๋ณ‘์šฉ
๋ง์ดˆ์‹ ๊ฒฝ๋ณ‘์ฆ ์ฃผ๋กœ Thalidomide
ํ”ผ๋กœ, ๋ฐœ์ง„, ์„ค์‚ฌ ๋นˆ๋ฒˆํ•œ ๋ถ€์ž‘์šฉ
๊ธฐํ˜• ์œ ๋ฐœ (๊ธฐํ˜•์›์„ฑ) ์—„๊ฒฉํ•œ ์ž„์‹  ์˜ˆ๋ฐฉ ํ”„๋กœ๊ทธ๋žจ ํ•„์š” (REMS)
 

๐Ÿ”ฌ IMiD์™€ T-cell ๊ธฐ๋ฐ˜ ์น˜๋ฃŒ ๋ณ‘์šฉ

IMiD๋Š” T cell ํ™œ์„ฑ์„ ์ฆ๊ฐ€์‹œ์ผœ, ๋‹ค์Œ๊ณผ ๊ฐ™์€ ๋ณ‘์šฉ์ „๋žต์—์„œ ์œ ํšจ์„ฑ์„ ๋†’์ž…๋‹ˆ๋‹ค:

  • Daratumumab + Lenalidomide + DEX (DRd)
  • BCMA TCE + Lenalidomide: ๋ฉด์—ญ์„ธํฌ ๊ทน๋Œ€ํ™” ๋ณ‘์šฉ
  • CAR-T ์ดํ›„ IMiD ์œ ์ง€์š”๋ฒ•: ์ผ๋ถ€ ์ž„์ƒ์—์„œ ์‹คํ—˜ ์ค‘

๐Ÿ“ˆ ์ œ์•ฝ ์‚ฐ์—… ์ธก๋ฉด

์ธก๋ฉด๋‚ด์šฉ
Revlimid ๋งค์ถœ ์•ฝ 90์–ต ๋‹ฌ๋Ÿฌ (BMS ์ธ์ˆ˜ ์‹œ ํ•ต์‹ฌ ํŒŒ์ดํ”„๋ผ์ธ)
ํŠนํ—ˆ ๋งŒ๋ฃŒ 2022๋…„ ๋ฏธ๊ตญ ํŠนํ—ˆ ๋งŒ๋ฃŒ → ์ œ๋„ค๋ฆญ ๊ฒฝ์Ÿ ์ค‘
ํ›„์†๋ฌผ์งˆ ๊ฐœ๋ฐœ CELMoD (next-gen CRBN modulator) ์ง„ํ–‰ ์ค‘: Iberdomide ๋“ฑ
 

๐Ÿ“Œ ์š”์•ฝ

  • IMiD๋Š” ๋‹ค๋ฐœ๊ณจ์ˆ˜์ข… ์น˜๋ฃŒ์˜ '๊ธฐ๋ฐ˜์š”๋ฒ•'
  • ๋ฉด์—ญ์ž‘์šฉ + ์ง์ ‘ํ•ญ์•” + ๋‹จ๋ฐฑ์งˆ ๋ถ„ํ•ด ์œ ๋„๊ฐ€ ํ•ต์‹ฌ ๊ธฐ์ „
  • T cell ๊ธฐ๋ฐ˜ ์น˜๋ฃŒ์ œ์™€ ๋ณ‘์šฉ ์‹œ ์‹œ๋„ˆ์ง€ ๊ธฐ๋Œ€
  • ํŠนํ—ˆ ๋งŒ๋ฃŒ์™€ ํ•จ๊ป˜ CELMoD ๋“ฑ ์ฐจ์„ธ๋Œ€ ๋ฌผ์งˆ์ด ํ™œ๋ฐœํžˆ ๊ฐœ๋ฐœ ์ค‘
๋ฐ˜์‘ํ˜•