肺移植后肺癌患者联用厄洛替尼和他克莫司致严重不良反应1例并文献复习  

One case report of serious adverse effect of erlotinib and tacrolimus in lung cancer patients after lung transplantation and literature review

作　　者：王方舟[1] 张明月[1] 王韧韬[1] 佘丹阳[1] WANG Fang-zhou;ZHANG Ming-yue;WANG Ren-tao;SHE Dan-yang(Department of Respiration, Chinese PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院呼吸科,北京100853

出　　处：《中国药物应用与监测》2017年第4期251-254,258,共5页Chinese Journal of Drug Application and Monitoring

摘　　要：患者中年男性,右肺移植术后11年,长期口服他克莫司(1 mg,bid)治疗,因发现肺部阴影入院,确诊左上肺肺腺癌Ⅳ期后口服厄洛替尼(150 mg,qd),用药后出现肾功能恶化,血肌酐最高为258.9μmol·L^(-1),并出现严重腹泻、呕吐等不良反应,他克莫司血药浓度轻度升高(5.7 ng·m L^(-1)),考虑不良反应的发生与厄洛替尼和他克莫司之间的药物相互作用有关,故减少他克莫司剂量并停用厄洛替尼,之后患者腹泻呕吐症状迅速缓解,肾功能恢复至入院前水平(166.9μmol·L^(-1)),后患者出院,未再出现药品不良反应。临床常用的肺癌分子靶向治疗药物和免疫抑制剂均经肝P450酶系代谢,同时又是P450酶系的抑制剂,联用时往往会加重彼此的不良反应,笔者对相关文献一并进行了复习。A middle-aged male patient,with the history of11years after the right lung transplantation and long-termuse of tacrolimus(1mg,bid),was hospitalized because of the discovery of lung shadows.After diagnosed of left upper lungadenocarcinoma stageⅣ,the patient received erlotinib(150mg,qd).Later,severe deterioration of kidney function,diarrhea,vomiting and other adverse reactions were found during medication.The highest concentration of serum creatinine was258.9μmol·L-1.Tacrolimus blood concentration was slightly elevated(5.7ng·mL-1).The drug interaction of erlotinib and tacrolimus maybe related with these adverse reactions.We reduced the tacrolimus dose and discontinued erlotinib.Diarrhea,vomiting and othersymptoms were rapidly relieved.Renal function of the patient returned to the level prior to admission(166.9μmol·L-1).The patientdid not appear adverse drug reaction later.The molecularly targeted therapy drugs and immunosuppressive agents commonly usedin clinical practice are all metabolized by CYP450,both of them are also the substrate of CYP450.The combined use of these drugsoften aggravates each other's adverse reactions.This article reviewed the related literature.

关 键 词：他克莫司 厄洛替尼 药物相互作用 肺腺癌 药品不良反应 

分 类 号：R734.2[医药卫生—肿瘤]