阿帕替尼与特瑞普利单抗联用致红皮病  

Erythroderma caused by apatinib combined with toripalimab

作　　者：薛淑一 陈晓琳 公静 张关敏[1] 张艳华[1] 尹月[1] Xue Shuyi;Chen Xiaolin;Gong Jing;Zhang Guanmin;Zhang Yanhua;Yin Yue(Department of Pharmacy,Peking University Cancer Hospital&Institute,Key laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Beijing 100142,China;Department of Pharmacy,Qingdao Central Hospital,Shandong Province,Qingdao 266042,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所药剂科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [2]青岛市中心医院药学部,青岛266042

出　　处：《药物不良反应杂志》2023年第8期508-510,共3页Adverse Drug Reactions Journal

摘　　要：1例66岁男性恶性黑色素瘤患者接受阿帕替尼(250 mg口服、1次/d)、替莫唑胺(口服,第1天500 mg,第2~4天400 mg/d)和特瑞普利单抗(240 mg静脉滴注、第1和第15天)联合治疗。5个周期(28 d为1个周期)后出现多发皮疹,可见头面部、躯干、四肢皮损,伴红疹、脱屑;全身水肿,四肢肿胀,双下肢为重,伴黏液渗出。第6个周期将阿帕替尼减量(250 mg口服、1次/3 d),皮疹未减轻。实验室检查示血清白蛋白28.5 g/L,血清总蛋白55.5 g/L,嗜酸粒细胞0.096,血钾3.17 mmol/L。考虑为阿帕替尼和特瑞普利单抗联用所致红皮病,停用2药,给予甲泼尼龙、氯雷他定、苯海拉明、曲安奈德益康唑乳膏(外用)、莫匹罗星软膏(外用)及皮肤护理,同时予补充蛋白、利尿、补钾、护胃等对症治疗。治疗10 d后皮疹消退,脱屑、瘙痒减轻。A 66⁃year⁃old male patient with malignant melanoma received combined treatments with apatinib(oral 250 mg once daily),temozolomide(oral 500 mg on day 1 and 400 mg/d on days 2⁃4),toripalimab(240 mg intravenous infusion on days 1 and 15).After 5 cycles(28 days as a cycle),the patient developed multiple rashes,which were not alleviated after reducing the dose of apatinib to 250 mg orally once every 3 days in the 6th treatment cycle.Laboratory tests showed that serum albumin was 28.5 g/L,total serum protein was 55.5 g/L,eosinophil percentage was 0.096,and venous potassium was 3.17 mmol/L.Erythroderma caused by combination of apatinib and toripalimab was considered,and the 2 drugs were stopped.The patient received the treatments of methylprednisolone,loratadine,diphenhydramine,triamcinolone acetonide and econazole nitrate cream and mupirocin ointment(external coating),and skin care.At the same time,symptomatic treatments such as protein supplement,diuresis,potassium supplement,and stomach protection were given.After 10 days of treatments,the rash subsided,and desquamation and itching were improved.

关 键 词：阿帕替尼 特瑞普利单抗 红皮病 皮肤不良反应 

分 类 号：R969[医药卫生—药理学]