对一例肺癌脑转移继发癫■病人的药物治疗实践与分析
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摘要
目的:探讨肺癌脑转移继发癫■病人在进行靶向及抗癫■治疗时的用药选择。方法:围绕1例肺癌脑转移继发癫■病人的临床资料进行回顾性分析。结果:临床药师建议将治疗病人表皮生长因子受体(epidermal growth factor receptor,EGFR)突变的原发性肺癌脑膜转移的靶向药物改为奥希替尼。针对肺癌脑转移继发癫■的治疗,临床药师建议停用与奥希替尼存在潜在相互作用的卡马西平,改用无肝酶诱导活性的丙戊酸钠,并依据血药浓度检测结果及时调整丙戊酸钠用药剂量,确保了临床用药的安全及有效。结论:临床药师参与肺癌脑转移继发癫■病人的治疗方案调整,保证了安全合理用药。
Objective: To investigate the choice of drugs for the treatment of a patient with epilepsy secondary to brain metastasis from lung cancer in the course of targeted and antiepileptic therapy. Methods: A retrospective analysis was made by using the clinical medical data of a patient with epilepsy secondary to brain metastasis from lung cancer. Results: Clinical pharmacists recommended that the targeted anti-cancer drug used for the treatment of the patient with epidermal growth factor receptor(EGFR) mutation and epilepsy secondary to brain metastasis from lung cancer be replaced with osimertinib. Aiming at the treatment of epilepsy secondary to brain metastasis from lung cancer, clinical pharmacists suggested that carbamazepine which might have potential interaction with osimertinib be abandoned, and valproate sodium, a non-enzyme-inducing activity antiepileptic drug, be used instead. Based on the detection results of therapeutic drug monitoring(TDM), the dosage of valproate sodium was timely adjusted. As a result, clinical medication safety and efficacy were ensured. Conclusion: Active involvement of pharmacists in proper adjustment of regimens in the treatment of the patient with epilepsy secondary to brain metastasis from lung cancer could ensure safe and rational use of drugs.
Objective: To investigate the choice of drugs for the treatment of a patient with epilepsy secondary to brain metastasis from lung cancer in the course of targeted and antiepileptic therapy. Methods: A retrospective analysis was made by using the clinical medical data of a patient with epilepsy secondary to brain metastasis from lung cancer. Results: Clinical pharmacists recommended that the targeted anti-cancer drug used for the treatment of the patient with epidermal growth factor receptor(EGFR) mutation and epilepsy secondary to brain metastasis from lung cancer be replaced with osimertinib. Aiming at the treatment of epilepsy secondary to brain metastasis from lung cancer, clinical pharmacists suggested that carbamazepine which might have potential interaction with osimertinib be abandoned, and valproate sodium, a non-enzyme-inducing activity antiepileptic drug, be used instead. Based on the detection results of therapeutic drug monitoring(TDM), the dosage of valproate sodium was timely adjusted. As a result, clinical medication safety and efficacy were ensured. Conclusion: Active involvement of pharmacists in proper adjustment of regimens in the treatment of the patient with epilepsy secondary to brain metastasis from lung cancer could ensure safe and rational use of drugs.
引文
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[2] Sasada T,Yamada T,Azuma K,et al.EGFR T790M mutation as a novel target for immunotherapy against EGFR-TKI-resistant non-small cell lung cancer[J].J Immunother Cancer,2013,1(Suppl 1):P235.
[3] 何璐,钱妍.Osimertinib治疗非小细胞肺癌的研究进展[J].中国新药与临床杂志,2016,35(6):398-404.HE Lu,QIAN Yan.Research progress of osimertinib in treating non-small cell lung cancer[J].Chin J New Drugs Clin Rem,2016,35(6):398-404.In Chinese with English abstract.
[4] AstraZeneca Pharmaceuticals LP.Full prescribing information for TAGRISSO (osimertinib) tablets[EB/OL].[2018-04-02].https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/208065s006lbl.pdf.
[5] Remon J,Planchard D.AZD9291 in EGFR-mutant advanced non-small-cell lung cancer patients[J].Future Oncol,2015,11(22):3069-3081.
[6] 石远凯,孙燕,于金明,等.中国肺癌脑转移诊治专家共识 (2017 年版)[J].中国肺癌杂志,2017,20(1):1-12.SHI Yuankai,SUN Yan,YU Jinming,et al.China experts consensus on the diagnosis and treatment of brain metastases of lung cancer (2017 version) [J].Chin J Lung Cancer,2017,20(1):1-12.In Chinese with English title.
[7] Kivist? K T,Kroemer H K,Eichelbaum M.The role of human cytochrome P450 enzymes in the metabolism of anticancer agents:implications for drug interactions[J].Br J Clin Pharmacol,1995,40(6):523-530.
[8] Khozin S,Weinstock C,Blumenthal G M,et al.Osimertinib for the treatment of metastatic EGFR T970M mutation-positive non-small cell lung cancer[J].Clin Cancer Res,2016,23(9):2131-2135.
[9] Dickinson P A,Cantarini M V,Collier J,et al.Metabolic disposition of osimertinib in rat,dog,and man:insights into a drug designed to bind covalently to a cysteine residue of EGFR[J].Drug Metab Dispos,2016,44(8):1201-1212.
[10] MIAO Xiusheng,YANG Jianjun,Metcalfe C D.Carbamazepine and its metabolites in wastewater and in biosolids in a municipal wastewater treatment plant[J].Environ Sci Technol,2005,39(19):7469-7475.
[11] Greig S L.Osimertinib:first global approval[J].Drugs,2016,76(2):263-273.
[12] van Breemen M S,Wilms E B,Vecht C J.Epilepsy in patients with brain tumours:epidemiology,mechanisms,and management[J].Lancet Neurol,2007,6(5):421-430.
[13] van Breemen M S,Rijsman R M,Taphoorn M J,et al.Efficacy of anti-epileptic drugs in patients with gliomas and seizures[J].J Neurol,2009,256(9):1519-1526.
[14] 班立丽,唐晓霞.丙戊酸钠血药浓度与抗癫■疗效及不良反应关系研究[J].中国医院用药评价与分析,2013,13(12):1086-1089.BAN Lili,TANG Xiaoxia.Association of blood concentration of sodium valproate with anti-epileptic efficacy and adverse drug reactions[J].Eval Anal Drug-use Hosp China,2013,13(12):1086-1089.In Chinese with English abstract.
[15] 王宏虹,毛桂福,谭强.丙戊酸钠血药浓度监测研究概况[J].齐鲁药事,2012,31(10):605-607.WANG Honghong,MAO Guifu,TAN Qiang.The research overview on blood concentration monitoring of sodium velproate[J].Qilu Pharm Aff,2012,31(10):605-607.In Chinese with English abstract.