肿瘤化疗相关性贫血的现状及展望  

Status and prospect of cancer chemotherapy-induced anemia

作　　者：赵东陆[1] 马军[1] Zhao Donglu;Ma Jun(Harbin First Hospital Hematologic Oncology Research Center,Hemato-oncology WardⅡ,Harbin 150028,China)

机构地区：[1]哈尔滨市第一医院血液肿瘤研究中心血液肿瘤科二病房,哈尔滨150028

出　　处：《中华医学杂志》2025年第6期421-427,共7页National Medical Journal of China

摘　　要：肿瘤化疗相关性贫血(CIA)是肿瘤患者最常见的并发症之一。CIA治疗效果不佳,将影响化疗方案的正常实施,并降低患者生存质量,缩短临床生存期。目前CIA存在治疗率严重不足、治疗效果不理想等问题,临床上常因贫血得不到快速有效的救治,而被迫降低化疗剂量或延迟化疗。究其原因,这些问题主要与疾病病因复杂、临床干预时机晚,现有治疗方案又存在一定局限等因素相关。因此,疾病管理需要进一步强化早诊早治理念,避免因贫血程度严重而增加临床负担。同时,随着对贫血机制的深入理解,临床开始基于低氧诱导因子(HIF)的综合调控机制进行新药研发。2023年欧洲内科肿瘤学会(ESMO)大会上公布了一项罗沙司他治疗非髓系恶性肿瘤患者化疗诱导性贫血的Ⅲ期临床研究,这款HIF脯氨酰羟化酶抑制剂(HIF-PHI)类药物为口服制剂,在研究中表现出了良好的疗效及安全性,并且与重组人红细胞生成素-α(rHuEPO-α)相比,依从性更优。本文从对CIA机制的再认识入手,对CIA目前的诊治困境进行分析,并结合《中国临床肿瘤学会(CSCO)肿瘤相关性贫血临床实践指南(2024版)》提出建议,同时就未来新型治疗药物HIF-PHI进行介绍与展望。Chemotherapy-induced anemia(CIA)is one of the most common complications in cancer patients.If CIA treatment is not effective,it will affect the normal implementation of chemotherapy regimens,and reduce the quality of life of patients and shorten clinical survival.At present,CIA has serious shortcomings in treatment rate and unsatisfactory therapeutic effect.It is often forced to reduce the dose of chemotherapy or delay chemotherapy due to anemia that cannot be rapidly and effectively treated in clinical practice.These problems are mainly related to factors such as complex etiology of the disease,late timing of clinical intervention,and certain limitations in existing treatment options.Therefore,disease management needs to further strengthen the concept of early diagnosis and early treatment to avoid the increased clinical burden due to the severity of anemia.Meanwhile,with the in-depth understanding of the mechanism of anemia,new drug research and development based on the comprehensive regulatory mechanism of hypoxia-inducible factor(HIF)has begun in clinical practice.A phaseⅢclinical study of Roxostat in the treatment of chemotherapy-induced anemia in patients with non-medullary malignancies was presented at the European Society of Medical Oncology(ESMO)conference in 2023.This hypoxia-inducible factor prolyl hydroxylase inhibitor(HIF-PHI)drug is an oral preparation,which has shown good efficacy and safety in the study,and has superior compliance compared with recombinant human erythropoietin-α(rHuEPO-α).Starting from the re-understanding of the mechanism of CIA,this review analyzes the current diagnosis and treatment dilemmas of CIA,puts forward suggestions in combination with the"Guildlines of Chinese Society of Clinical Oncology(CSCO)clinical practice in tumor-related anemia(2024)",and introduces and looks forward to HIF-PHI,a new therapeutic drug in the future.

关 键 词：贫血 肿瘤化疗相关性贫血 低氧诱导因子脯氨酰羟化酶抑制剂 红细胞生成刺激剂 

分 类 号：R730.53[医药卫生—肿瘤] R556[医药卫生—临床医学]