1例骨肉瘤患者大剂量甲氨蝶呤化疗致肝功能损伤的药学监护
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摘要
临床药师参与1例骨肉瘤患者大剂量甲氨蝶呤化疗导致严重肝功能损伤治疗,借助治疗药物监测及个体化用药相关基因检测技术,对化疗方案和肝损伤原因进行分析,协助制定护肝治疗方案并对后续化疗方案进行优化。通过临床药师的介入,患者的肝功能逐渐恢复正常,下一周期化疗顺利按时进行。临床药师基于个体化用药技术,积极参与骨肉瘤患者的临床治疗,有助于提高抗肿瘤药物治疗的安全性及有效性。
Clinical pharmacist participated in the treatment of an osteosarcoma patient with severe hepatic impairment caused by highdose methotrexate. With the help of therapeutic drug monitor and individualized drug-related gene detection technology, the chemotherapy scheme and the causes of liver injury were analyzed to assist in the formulation of hepatoprotective treatment scheme and the optimization of follow-up chemotherapy scheme. With the participation of clinical pharmacist, the patient's liver function gradually returned to normal, and the next cycle of chemotherapy proceeded smoothly and on time. Clinical pharmacists actively participate in the clinical treatment of osteosarcoma based on individualized drug use technology, which is helpful to improve the safety and effectiveness of antineoplastic drugs.
Clinical pharmacist participated in the treatment of an osteosarcoma patient with severe hepatic impairment caused by highdose methotrexate. With the help of therapeutic drug monitor and individualized drug-related gene detection technology, the chemotherapy scheme and the causes of liver injury were analyzed to assist in the formulation of hepatoprotective treatment scheme and the optimization of follow-up chemotherapy scheme. With the participation of clinical pharmacist, the patient's liver function gradually returned to normal, and the next cycle of chemotherapy proceeded smoothly and on time. Clinical pharmacists actively participate in the clinical treatment of osteosarcoma based on individualized drug use technology, which is helpful to improve the safety and effectiveness of antineoplastic drugs.
引文
[1]中华医学会肝病学分会药物性肝病学组.药物性肝损伤诊治指南[J].中国病毒病杂志,2015,23(5):1752-1769.
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[5] Biermann J S,Chow W,Reed D R,et al. NCCN guidelines insights:bone cancer, version 2. 2017[J]. J Natl Compr Canc Netw,2017,15(2):155-167.
[6] Bacci G,Ferrari S,Delepine N,et al. Predictive factors of histologic response to primary chemotherapy in osteosarcoma of the extremity:study of 272 patients preoperatively treated with highdose methotrexate, doxorubicin, and cisplatin[J]. J Clin Oncol,1998,16(2):658-663.
[7] Crews K R,Liu T,Rodriguez-Galindo C,et al. High-dose methotrexate pharmacokinetics and outcome of children and young adults with osteosarcoma[J]. Cancer,2004,100(8):1724-1733.
[8] Holmboe L,Andersen A M,M(?)rkrid L,et al. High dose methotrexate chemotherapy:pharmacokinetics,folate and toxicity in osteosarcoma patients[J]. Br J Clin Pharmacol, 2012,73(1):106-114.
[9]刘晶霞,陈洁平,谭文,等.亚甲基四氢叶酸还原酶基因多态性与急性淋巴细胞白血病患者甲氨蝶呤化疗毒副反应的研究[J].中国实验血液学杂志,2008,16(3):488-492.
[10] Suthandiram S,Gan G G,Zain S M,et al. Effect of polymorphisms within methotrexate pathway genes on methotrexate toxicity and plasma levels in adults with hematological malignancies[J]. Pharmacogenomics,2014,15(11):1479-1494.
[11] Yang L,Wu H,Gelder T V,et al. SLCOIB1 rs4149056 genetic polymorphism predicting methotrexate toxicity in Chinese patients with non-Hodgkin lymphoma[J]. Pharmacogenomics, 2017,18(17):1557-1562.
[12]曹俊杰,裴仁治,马俊霞,等.异甘草酸镁联合还原型谷胱甘肽治疗血液病患者化疗后药物性肝损害临床观察[J].中国药物与临床,2012,12(1):105-106.
[2]于世英,姚阳.肿瘤药物相关性肝损伤防治专家共识[M].北京:中国协和医科大学出版社,2014.
[3] Chalasani N P,Hayashi P H,Bonkovsky H L,et al. ACG Clinical guideline:the diagnosis and management of idiosyncratic drug-induced liver injury[J]. Am J Gastroenterol, 2014, 109(7):950-966.
[4] Howard S C,McCormick J,Pui C H,et al. Preventing and managing toxicities of high-dose methotrexate[J]. Oncologist,2016,21(12):1471-1482.
[5] Biermann J S,Chow W,Reed D R,et al. NCCN guidelines insights:bone cancer, version 2. 2017[J]. J Natl Compr Canc Netw,2017,15(2):155-167.
[6] Bacci G,Ferrari S,Delepine N,et al. Predictive factors of histologic response to primary chemotherapy in osteosarcoma of the extremity:study of 272 patients preoperatively treated with highdose methotrexate, doxorubicin, and cisplatin[J]. J Clin Oncol,1998,16(2):658-663.
[7] Crews K R,Liu T,Rodriguez-Galindo C,et al. High-dose methotrexate pharmacokinetics and outcome of children and young adults with osteosarcoma[J]. Cancer,2004,100(8):1724-1733.
[8] Holmboe L,Andersen A M,M(?)rkrid L,et al. High dose methotrexate chemotherapy:pharmacokinetics,folate and toxicity in osteosarcoma patients[J]. Br J Clin Pharmacol, 2012,73(1):106-114.
[9]刘晶霞,陈洁平,谭文,等.亚甲基四氢叶酸还原酶基因多态性与急性淋巴细胞白血病患者甲氨蝶呤化疗毒副反应的研究[J].中国实验血液学杂志,2008,16(3):488-492.
[10] Suthandiram S,Gan G G,Zain S M,et al. Effect of polymorphisms within methotrexate pathway genes on methotrexate toxicity and plasma levels in adults with hematological malignancies[J]. Pharmacogenomics,2014,15(11):1479-1494.
[11] Yang L,Wu H,Gelder T V,et al. SLCOIB1 rs4149056 genetic polymorphism predicting methotrexate toxicity in Chinese patients with non-Hodgkin lymphoma[J]. Pharmacogenomics, 2017,18(17):1557-1562.
[12]曹俊杰,裴仁治,马俊霞,等.异甘草酸镁联合还原型谷胱甘肽治疗血液病患者化疗后药物性肝损害临床观察[J].中国药物与临床,2012,12(1):105-106.