1例阿来替尼致ALK阳性NSCLC患者罕见不良反应的药学监护  

Pharmaceutical care for rare ADR in a patient with ALK-positive non-small cell lung cancer induced by alectinib

作　　者：杜中英 郑兆红 魏亮 侯秋雨[2] DU Zhongying;ZHENG Zhaohong;WEI Liang;HOU Qiuyu(Dept.of Pharmacy,Qingdao Eighth People’s Hospital,Shandong Qingdao 266100,China;Dept.of Cardio-thoracic Surgery,Qingdao Eighth People’s Hospital,Shandong Qingdao 266100,China)

机构地区：[1]青岛市第八人民医院药学部,山东青岛266100 [2]青岛市第八人民医院心胸外科,山东青岛266100

出　　处：《中国药房》2024年第2期247-250,共4页China Pharmacy

基　　金：青岛市医药卫生科研计划项目(No.2023-WJZD094,No.2021-WJZD113)。

摘　　要：目的为间变性淋巴瘤激酶(ALK)阳性非小细胞肺癌(NSCLC)患者的安全用药提供参考。方法临床药师参与1例ALK阳性NSCLC患者服用阿来替尼后,出现双侧胸腔积液并发溶血性贫血的诊治过程。针对患者胸腔积液、溶血性贫血等症状,临床药师排查患者的既往用药史和疾病史,以及可能存在药物相互作用的因素;同时根据患者服用阿来替尼与胸腔积液和溶血性贫血的时间相关性,建议停用阿来替尼,待患者相关症状改善后,建议减量使用阿来替尼。但该患者再次出现双侧胸腔积液和溶血性贫血,临床药师根据诺氏评估量表评估阿来替尼与双侧胸腔积液、溶血性贫血的相关性后,建议永久停用阿来替尼,并与临床医生共同建议患者更换为恩沙替尼。结果临床医生采纳临床药师的建议。换药后,该患者的胸腔积液消退,溶血性贫血症状改善。阿来替尼与双侧胸腔积液、溶血性贫血的相关性均为“确定”。结论临床药师通过参与ALK阳性NSCLC患者的药学监护,协助临床医生制定个体化用药方案,保障了患者用药的安全性。OBJECTIVE To provide reference for safe drug use in patients with anaplastic lymphoma kinase(ALK)-positive non-small cell lung cancer(NSCLC).METHODS Clinical pharmacists participated in the diagnosis and treatment of a patient with ALK-positive NSCLC who developed bilateral pleural effusion and hemolytic anemia after taking alectinib;regarding symptoms such as pleural effusion and hemolytic anemia in the patient,clinical pharmacists investigated the patient’s history of medication and disease,as well as potential drug interaction;to consider the correlation between the patient’s use of alectinib and the duration of pleural effusion and hemolytic anemia,clinical pharmacists suggested that clinical doctors discontinued alectinib and used reduced dose treatment after the pleural effusion improved,but the patient suffered from bilateral pleural effusion and hemolytic anemia again;after evaluating the correlation between alectinib and bilateral pleural effusion and hemolytic anemia using the Naranjo’s assessment scale,clinical pharmacists recommend permanent discontinuation of alectinib and jointly recommend replacement with ensartinib with clinical physicians.RESULTS Physicians adopted the suggestions of clinical pharmacists.The pleural effusion subsequently regressed and hemolytic anemia improved after replacing the drug.The correlation between alectinib and bilateral pleural effusion and hemolytic anemia was confirmed.CONCLUSIONS Clinical pharmacists participate in pharmaceutical monitoring of ALK-positive NSCLC patients,assist clinical doctors in developing personalized medication recommendations,and ensure the safety of patient medication.

关 键 词：阿来替尼 胸腔积液 溶血性贫血 药学监护 

分 类 号：R969.3[医药卫生—药理学]