1例晚期乳腺癌并发甲状腺癌患者重启蒽环类药物化疗的药学监护  

Pharmaceutical care of reactivating anthracycline chemotherapy in a patient with advanced breast cancer combined with thyroid cancer

作　　者：张广全 鹿琦 燕丹[2] 徐思露 ZHANG Guangquan;LU Qi;YAN Dan;XU Silu(Dept.of Pharmaceutical Administration,Changzhou Cancer Hospital,Jiangsu Changzhou 213032,China;Dept.of Pharmacy,Jiangsu Cancer Hospital/Jiangsu Institute of Cancer Research/the Affiliated Cancer Hospital of Nanjing Medical University,Nanjing 210009,China;Dept.of Pharmacy,Xuzhou Cancer Hospital,Jiangsu Xuzhou 221005,China)

机构地区：[1]常州市肿瘤医院药事科,江苏常州213032 [2]江苏省肿瘤医院/江苏省肿瘤防治研究所/南京医科大学附属肿瘤医院药学部,南京210009 [3]徐州市肿瘤医院药剂科,江苏徐州221005

出　　处：《中国药房》2024年第12期1527-1532,共6页China Pharmacy

基　　金：国家自然科学基金青年科学基金项目(No.81703596);常州市科技局科技计划项目(No.CJ20229035)。

摘　　要：目的 探讨晚期乳腺癌并发甲状腺癌患者重启蒽环类药物的药学监护思路。方法 临床药师全程参与1例晚期乳腺癌合并甲状腺癌患者的治疗过程,为患者提供个体化用药建议。考虑患者存在多种抗肿瘤药物原发耐药,临床药师建议重新启用EC解救方案(静脉滴注表柔比星140 mg和环磷酰胺1 g,d1,21 d为一周期),并结合患者体重变化估算表柔比星终生累积剂量及最佳化疗疗程;针对患者化疗期间促甲状腺激素(TSH)水平异常波动可能增加心脏毒性发生风险的问题,临床药师建议根据TSH目标范围和检测结果,采取“前快后慢”的左甲状腺激素钠片剂量调整策略。结果 医师采纳药师建议;临床药师协助医师重启以蒽环类药物为基础的7周期联合治疗方案。期间患者未出现明显心脏不良事件,病情稳定;左甲状腺素钠片加量后患者TSH水平稳步下降,未出现相关不良反应。结论 对多种抗肿瘤药物原发耐药的乳腺癌并发甲状腺癌患者,在必要时可重新启用蒽环类药物,但启用前应进行基线心功能检查及甲状腺激素水平检测,并结合患者既往病史开展心脏毒性风险评估。临床药师应积极发挥专业优势,对此类患者开展全程药学监护,保障患者用药安全。OBJECTIVE To explore the pharmaceutical care of reactivating anthracycline chemotherapy in patients with advanced breast cancer complicated with thyroid cancer.METHODS Clinical pharmacists participated in the whole treatment process of a patient with advanced breast cancer complicated with thyroid cancer and provided personalized medication recommendations.Considering that the patient currently has multiple primary anti-tumor drug resistance,clinical pharmacists recommend reactivating the EC rescue protocol(intravenous infusion of epirubicin hydrochloride 140 mg+cyclophosphamide 1 g,d1,21 days for a cycle).The cumulative lifetime dose of epirubicin and the optimal course of chemotherapy was estimated according to the body weight change of the patient.Given the issue that abnormal fluctuation of thyroid stimulating hormone(TSH) level during chemotherapy may increase the risk of cardiac toxicity,clinical pharmacists suggest adopting a dose adjustment strategy of “fast first and slow later” for Levothyroxine sodium tablet according to the target range of TSH and test results.RESULTS The doctors adopted the pharmacists' suggestion;the clinical pharmacists assisted the doctors in reactivating the anthracycline-based 7-cycle combination regimen,during which the patient had no significant cardiac adverse events and was repeatedly evaluated as stable.TSH decreased steadily after Levothyroxine sodium tablets were added,and no adverse reaction related to TSH inhibition was observed.CONCLUSIONS Patients with primary drug-resistant breast cancer complicated with thyroid cancer may be reactived anthracyclines if necessary,but baseline cardiac function and thyroid hormone levels should be tested before initiation,and cardiac toxicity risk assessment should be performed in combination with the patient's history.Clinical pharmacists should actively exert their professional advantages to carry out whole-process pharmaceutical care for such patients,so as to ensure the safety of drug use for patients.

关 键 词：蒽环类药物 乳腺癌 甲状腺癌 药学监护 临床药师 

分 类 号：R969.3[医药卫生—药理学]