摘要
目的探讨PD-1抑制剂临床应用中联用方案及其用药顺序。方法通过HIS检索某院日间化疗中心PD-1抑制剂(含帕博利珠单抗与纳武利尤单抗)在2018年7~10月的医嘱并查阅病案及相关检验数据,分析患者基本信息和用药医嘱、联合治疗方案及其用药顺序情况。结果 184例患者使用PD-1抑制剂共347治疗人次,患者以男性居多(60.87%),而年龄集中在40~69岁(72.83%),主要分布于内科门诊(42.39%)、妇科门诊(20.11%)和肝胆胰门诊(10.33%),所患疾病主要为肺癌(27.17%)、肝癌(11.41%)与淋巴癌(10.33%)。联合用药方案主要为无联合单药使用(40.76%)、联合化疗(29.89%)和联合抗血管生成药物治疗(15.76%)为主。在60例联合用药方案中,用药顺序数据中53.33%为先使用抗PD-1再使用化疗/抗血管生成药物治疗,而20%为先使用化疗/抗血管生成药物治疗后使用抗PD-1治疗,余下26.67%为联合用药顺序间隔7 d以上。同一天内先使用抗PD-1药物再使用化疗药物/抗血管生成药物治疗不良反应发生率最低(44.44%)。结论临床存在不少超药品说明书用法及不同的用药顺序方案,需更多的临床数据以探讨最佳的联合治疗方法及用药顺序,为肿瘤患者带来更多的获益。
OBJECTIVE To investigate the combined treatment schemes of PD-1 inhibitors in clinical practice and the administration sequences. METHODS Medical records and relevant test data of PD-1 inhibitors(including pembrolizumab and nivolumab)from July to October 2018 in the day-time chemotherapy center of a hospital were searched by HIS.The basic information of the patients and treatment concentration,combined treatment scheme and adverse reactions were analyzed. RESULTS A total of 184 patients with PD-1 inhibitors treated 347 times,in the majority with male patients(60.87%),and focused on the ages of 40 to 69 years(72.83%),mainly distributed in the internal medicine department(42.39%),gynecology clinic(20.11%) and hepatobiliary and pancreatic clinic(10.33%),the disease mainly for lung cancer(27.17%),liver cancer(11.41%) and lymph cancer(10.33%).The combination drugs were mainly used alone without combination(40.76%),combined chemotherapy(29.89%) and combined anti-angiogenesis therapy(15.76%).Among the 60 patients,53.33% were treated first with anti-PD-1 followed by chemotherapy/anti-vascular endothelial factor therapy,while 20% were treated first with chemotherapy/anti-vascular endothelial factor followed by anti-PD-1 therapy,and the remaining 26.67% were treated with the combination for more than 7 days.The incidence of adverse event to the lowest(44.44%) when treated first with anti-PD-1 followed by chemotherapy/anti-vascular endothelial factor therapy in one day. CONCLUSION There are many off-label drug instructions and different drug order schemes in clinical practice.It needs a large amount of clinical data to explore the best combination schemes and administration sequences,so as to bring more benefits to tumor patients.
作者
丘九望
卢翠婷
曾晓华
陈卓佳
刘韬
梁蔚婷
QIU Jiuwang;LU Cuiting;ZENG Xiaohua;CHEN Zhuojia;LIU Tao;LIANG Weiting(Pharmacy of Sun Yat-Sen University Cancer Center/State Key Laboratory of Oncology in South China/Collaborative Innovation Center for Cancer Medicine,Guangzhou,Guangdong 510060,China)
出处
《今日药学》
CAS
2019年第12期812-815,共4页
Pharmacy Today
基金
广东省医院药学研究基金(2019YX16)
