临床药师参与1例纳武利尤单抗致棘皮瘤的处置与分析  

Practice and analysis of clinical pharmacist participating in the treatment of a case of acanthoma caused by navulizumab

作　　者：宋霞[1] 鱼丽莉 赵慧[1] SONG Xia;YU Lili;ZHAO Hui(Dept.of Pharmacy,Lanzhou University Second Hospital,Lanzhou 730030,China;Dept.of Medical Oncology,Lanzhou University Second Hospital,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院药剂科,兰州730030 [2]兰州大学第二医院肿瘤内科,兰州730030

出　　处：《中国药房》2023年第2期237-241,共5页China Pharmacy

基　　金：甘肃省自然科学基金资助项目(No.22JR5RA991)。

摘　　要：本文报道了临床药师参与的1例纳武利尤单抗致棘皮瘤患者的诊治过程。该例患者使用纳武利尤单抗2周后发生棘皮瘤,累及头皮、颈部、躯干、手背、脚底等部位,并伴有中度瘙痒,经临床药师按照不良反应因果关系评价方法判定为“肯定”。临床药师查阅文献发现,免疫检查点抑制剂致棘皮瘤以男性、高龄、恶性黑色素瘤患者多见,好发于躯干、四肢及手部,局部手术及糖皮质激素治疗是主要的处置手段。临床药师在考虑治疗药物有效性、安全性、经济性、可及性的基础上,最大限度尊重患者意愿,与医师讨论后决定予患者卤米松乳膏外用+维A酸胶囊口服+依巴斯汀片口服的综合治疗方案,并予患者继续使用纳武利尤单抗行免疫治疗,同时由临床药师进行药学监护和心理疏导。最终,该例患者顺利完成治疗,棘皮瘤在纳武利尤单抗治疗结束后逐渐消退。该例患者的诊治过程表明,临床药师的参与有助于提高患者免疫治疗的连续性与安全性。This paper reports the clinical pharmacist participated in the diagnosis and treatment of a patient with acanthoma caused by nivolumab.This patient developed acanthoma 2 weeks after medication,involving scalp,neck,trunk,back of hand,sole of foot and other parts,with moderate pruritus.The clinical pharmacist determined it as“yes”according to the causality evaluation method of adverse reactions.After reviewing the literature,clinical pharmacists found that acanthoma caused by immune checkpoint inhibitors was more commonly seen in male elderly patients with malignant melanoma,and mainly involved the trunk,extremities and hands.Under the general principle of considering the effectiveness,safety,economy and accessibility of therapeutic drugs,the clinical pharmacist finally decided to give the patient a comprehensive treatment scheme of Halometasone cream for external use+oral administration of Retinoic acid capsules+oral administration of Ebastine tablets after discussion with the doctor,with maximum respect for the patient’s wishes,and continued to use navulizumab for immunotherapy.At the same time,pharmaceutical care and psychological counseling were conducted by clinical pharmacist.Finally,the patient successfully completed the treatment,and the acanthoma gradually subsided after the end of navulizumab treatment.The diagnosis and treatment process of this patient indicated that the participation of clinical pharmacists is helpful to improve the continuity and safety of immunotherapy.

关 键 词：纳武利尤单抗 棘皮瘤 皮肤免疫相关不良反应 临床药师 预后 

分 类 号：R969.3[医药卫生—药理学]