1例肝功能异常胰腺癌患者的抗肿瘤治疗用药分析

One Case of Drug Analysis About Antitumor Therapy in a Pancreatic Cancer Patient with Abnormal Liver Function

关键词:  肝功能异常  胰腺癌  紫杉醇(白蛋白结合型)  替吉奥

Key words:  abnormal liver function  pancreatic cancer  albumin-bound paclitaxel  S-1

摘要:

目的 通过掌握因病情发展导致肝功能异常患者的抗肿瘤治疗药物选择、用药剂量调整和药品不良反应监测等相关知识，临床药师为此类特殊患者的安全用药提供依据。方法 临床药师通过对1例胰腺癌Ⅳ期肝转移合并肝功能异常患者进行药学监护，结合患者个体情况和相关文献，对该患者抗肿瘤治疗过程中的药物选择、用药剂量调整、药品不良反应监测等提供用药建议。结果 通过对该患者2个周期抗肿瘤治疗前后的药学监护，临床药师认为患者的肝功能异常改变了化疗药物注射用紫杉醇（白蛋白结合型）和替吉奥胶囊的药动学特性，降低了2种化疗药物的代谢和排泄能力，在抗肿瘤治疗过程中，应降低注射用紫杉醇（白蛋白结合型）的单位面积给药剂量，选用“隔日口服替吉奥胶囊”法。但医师未及时调整用药，患者在2周期化疗后出现了严重的毒性反应（Ⅳ度骨髓抑制、粒细胞缺乏合并发热、Ⅲ度口腔黏膜炎）。结论 对于通过抗肿瘤治疗可以获益的肝功能异常患者，治疗时医师需要充分评价患者肝功能损伤类型，胆红素增高病因，临床药师要为医师提供抗肿瘤药物代谢特征和剂量调整方面的资料，共同为患者选择不良反应小、耐受性好的抗肿瘤治疗方案。

Abstract:

OBJECTIVE To understand antitumor drug choice, dosage adjustment and adverse drug reaction monitoring and other related knowledge about the patients with abnormal liver function caused by illness development, the clinical pharmacists provide the basis for safe medication of the patients with such special clinical application. METHODS The clinical pharmacist implemented pharmaceutical care for one case of Ⅳ stage pancreatic cancer patient with liver metastasis and abnormal liver function. The clinical pharmacist provided medical advice about the drug choice, dosage adjustment, adverse drug reaction monitoring, combined with the patient's individual condition and related literature. RESULTS Through pharmaceutical care about the patient with two cycle of antitumor therapy, the clinical pharmacist indicated that abnormal liver function changed the pharmacokinetic characteristics of albumin-bound paclitaxel and S-1, reduced the metabolism and excretion capacity of two drugs. The clinical pharmacist suggested reducing dosage per unit area of albumin-bound paclitaxel and choosing alternate-day treatment of S-1. While the doctor didn't adjust the dosage in time, the patient appeared severe toxicity after 2 cycles of chemotherapy, such as myelosuppression(garde Ⅳ), agranulocytosis with fever, oral ulcer(grade Ⅲ). CONCLUSION Some patients with abnormal liver function can benefit from anti-tumor therapy. Doctors require full evaluation about the types of liver function injury, the etiology of bilirubin, while clinical pharmacists provide massages about metabolism characteristics and dosage adjustment of antitumor drugs. They choose anti-tumor treatment for the patients preferred low toxicity and good tolerance.