摘要
目的为晚期肺腺癌免疫检查点抑制剂治疗后同时发生多种免疫相关不良事件(irAEs)患者的药学分析和监护提供经验和参考。方法回顾性分析临床药师参与的1例晚期肺腺癌患者使用特瑞普利单抗联合化疗一线解救治疗后出现多种irAEs的诊疗过程,从irAEs的发生、判定和处理等整个治疗过程进行分析及监护。结果本例患者应用特瑞普利单抗治疗后,同时发生免疫相关性心肌炎、重症肌无力、肝损伤不良反应,通过甲泼尼龙琥珀酸钠粉针治疗,各项指标持续呈下降趋势,各器官损伤均有明显改善。在激素减量过程中,部分指标回升,调整激素用量后,患者病情趋于平稳,各项毒性反应均有明显改善。结论既往应用免疫检查点抑制剂(ICIs)发生的不良反应多为1~2种,而多种不良反应同时发生的事件比较少见,临床药师参与临床治疗及药学监护,了解特瑞普利单抗引起的irAEs的特征,结合患者情况,制定个体化给药方案,确保治疗的安全性及有效性。
Objective To provide experience and reference for pharmaceutical analysis and monitoring of patients with multiple immune-related adverse events(irAEs)after immune checkpoint inhibitor therapy for advanced lung adenocarcinoma.Methods A case of advanced lung adenocarcinoma with the involvement of clinical pharmacists was retrospectively analyzed.The diagnosis and treatment of multiple irAEs after first-line rescue treatment with toripalimab combined with chemotherapy were analyzed and monitored concerning the occurrence,diagnosis and treatment of irAEs.Results The patient suffered from immune-related myocarditis,myasthenia gravis and liver injury after the treatment with toripalimab.After the treatment with methylprednisolone sodium succinate powder needle,all the indicators continued to decrease,and all the organ injuries were significantly improved.In the process of hormone dosage reduction,some indexes recovered.After adjusting the dosage of hormone,the patient′s condition tended to be stable,and all toxic reactions were significantly improved.Conclusion There were 1~2 kinds of adverse reactions after using immune checkpoint inhibitors(ICIs)in most cases,while the simultaneous occurrence of multiple adverse reactions was relatively rare.Clinical pharmacists participate in the clinical treatment and pharmaceutical care,understand the characteristics of irAEs caused by toripalimab,and formulate an individualized administration plan based on the patient′s situation to ensure the safety and effectiveness of treatment.
作者
王怡诺
丁震宇
赵庆春
谢丹妮
Wang Yinuo;Ding Zhenyu;Zhao Qingchun;Xie Danni(Department of Pharmacy,General Hospital of Northern Theater Command,Shenyang 110016,China;Department of Oncology,General Hospital of Northern Theater Command,Shenyang 110016,China)
出处
《实用药物与临床》
CAS
2023年第3期233-236,共4页
Practical Pharmacy and Clinical Remedies
关键词
肺腺癌
免疫相关不良事件
药学监护
免疫检查点抑制剂
Lung adenocarcinoma
Immune-related adverse reactions
Pharmacological monitoring
Immune checkpoint inhibitors
