BRAF V600E阳性突变晚期非小细胞肺癌患者治疗策略分析及药学监护

Analysis of Treatment Strategies and Pharmacological Monitoring for Patients with Advanced Non-small Cell Lung Cancer with BRAF V600E Positive Mutation

关键词:  肺肿瘤  靶向治疗  不良反应  合理用药

Key words:  lung neoplasms  targeted therapy  adverse reaction  rational drug use

摘要:

目的 探讨鼠类肉瘤滤过性毒菌致癌基因同源体B1(v-Raf murine sarcoma viral oncogene homolog B1，BRAF) V600E阳性突变的晚期非小细胞肺癌(non-small cell lung cancer，NSCLC)患者治疗方案的疗效和安全性，为该类患者的药学监护提供参考。方法 分析天津医科大学肿瘤医院2018—2019年收治的2例BRAF V600E阳性突变的晚期NSCLC患者，结合患者疾病变化及诊疗指南对治疗方案进行评估，以药物使用方法、用药教育及不良反应监测为切入点，为BRAF阳性突变的晚期NSCLC患者实施药学监护，并协助临床医师及时处理相关不良反应。结果 2例BRAF V600E突变的晚期NSCLC患者在接受BRAF、丝裂原活化的细胞外信号调节激酶抑制剂联合治疗后均显示出一定的抗肿瘤活性，且不良反应均在可控范围。结论 临床药师通过药学监护可促进临床合理用药，保障患者用药的安全性和有效性。

Abstract:

OBJECTIVE To explore the efficacy and safety of treatment regimens for patients with advanced non-small cell lung cancer(NSCLC) with v-Raf murine sarcoma viral oncogene homolog B1(BRAF) V600E positive mutation, and to provide reference for pharmacological monitoring of these patients. METHODS Two cases of advanced NSCLC patients with BRAF V600E positive mutation admitted to Tianjin Medical University Cancer Institute & Hospital from 2018 to 2019 were analyzed, and the treatment regimens were evaluated in the context of the patients’ disease changes and treatment guidelines, with drug use, medication education and adverse reaction monitoring as the starting points. To implement pharmaceutical care for advanced NSCLC patients with BRAF-positive mutations, and assist clinicians to deal with related adverse reactions in a timely manner. RESULTS Two patients with advanced NSCLC with BRAF V600E mutation showed certain antitumor activity after receiving BRAF and mitogen-activated extracellular signal-regulated kinase inhibitor combination therapy, and the adverse reactions were within the control range. CONCLUSION Clinical pharmacists can promote rational clinical use of drugs through pharmacological monitoring, aiming to protect the safety and efficacy of patients’ medications.