多腺苷二磷酸核糖聚合酶抑制剂不良反应管理指导意见  

Guidance on the management of adverse reactions induced by poly(ADP-ribose)polymerase inhibitors

作　　者：浙江省医学会妇产科学分会 浙江省医学会泌尿外科学分会 浙江省抗癌协会乳腺癌专业委员会 浙江省抗癌协会肿瘤临床药学专业委员会(筹) 浙江省数理医学学会泌尿专业委员会 黄萍 郑小卫 沈源明 张英丽 周峰[4] 吕卫国 朱笕青 张大宏[2] 丁国庆 金百冶 王晓稼 张瑾 Society of Obstetrics and Gynecology of Zhejiang Medical Association;Society of Urology of Zhejiang Medical Association;Committee of Breast Cancer of Zhejiang Anticancer Association;Committee of Clinical Pharmacy on Oncology of Zhejiang Anticancer Association(preparation);Committee of Urology of Zhejiang Society for Mathematical Medicine;HUANG Ping

机构地区：[1]不详 [2]浙江省人民医院 [3]中国科学院大学附属肿瘤医院 [4]浙江大学医学院附属第一医院 [5]浙江大学医学院附属邵逸夫医院

出　　处：《浙江大学学报（医学版）》2022年第6期765-774,共10页Journal of Zhejiang University(Medical Sciences)

基　　金：国家自然科学基金(82003189);浙江省“万人计划”(2020R52029);浙江省卫生高层次人才培养工程[浙卫办(2022)32号,浙卫办(2020)18号]。

摘　　要：多腺苷二磷酸核糖聚合酶(PARP)抑制剂的常见不良反应包括血液系统不良反应、消化系统不良反应和疲劳等。血液系统不良反应防治要点包括定期监测血常规,在常规治疗无效时转至血液科就诊,警惕骨髓增生异常综合征/急性髓系白血病的发生;消化系统不良反应防治重点包括服药时间正确、食物清淡、饮水适量,及时对症处理、预期性恶心呕吐预防等;疲劳的原因多样,在处理前应充分评估原因,并根据需要给予按摩疗法、心理社会干预等非药物治疗和哌甲酯、西洋参等药物治疗。此外,尼拉帕利和氟唑帕利会导致高血压、高血压危象及心悸,使用过程应注意监测血压、心率,及时对症处理,必要时进行多学科会诊。当患者用药期间出现咳嗽、呼吸困难时,应行高分辨率CT、支气管镜等检查排查肺炎,必要时停止PARP抑制剂,给予糖皮质激素和抗菌药物治疗。最后,还应重视PARP抑制剂的药物相互作用管理、患者自我管理和定期监测随访,以最大程度降低不良反应的风险和危害。The common adverse reactions caused by poly(ADP-ribose)polymerase(PARP)inhibitors include hematological toxicity,gastrointestinal toxicity and fatigue.The main prevention and treatment of hematological toxicity include:regular blood tests,referral to hematology department when routine treatment is ineffective,and being alert of myelodysplastic syndrome/acute myeloid leukemia.The key points to deal with gastrointestinal toxicity include:taking medicine at the right time,light diet,appropriate amount of drinking water,timely symptomatic treatment,prevention of expected nausea and vomiting,and so on.For fatigue,full assessment should be completed before treatment because the causes of fatigue are various;the management includes massage therapy,psychosocial interventions and drugs such as methylphenidate andPanax quinquefolius according to the severity.In addition,niraparib and fluzoparib can cause hypertension,hypertensive crisis and palpitation.Blood pressure and heart rate monitoring,timely symptomatic treatment,and multidisciplinary consultation should be taken if necessary.When cough and dyspnea occur,high resolution CT and bronchoscopy should be performed to exclude pneumonia.If necessary,PARP inhibitors should be stopped,and glucocorticoid and antimicrobial therapy should be given.Finally,more attention should be paid to drug interaction management,patient self-management and regular monitoring to minimize the risk and harm of adverse reactions of PARP inhibitors.

关 键 词：多腺苷二磷酸核糖聚合酶抑制剂 PARP 不良反应 临床管理 专家意见 

分 类 号：R969.2[医药卫生—药理学]