今日药学

2019, v.29(12) 812-815

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日间化疗中心PD-1抑制剂联用方案及用药顺序初步探讨
Preliminary Discussion for the Combinations and Administration Sequence of PD-1 Inhibitors in the Day-time Chemotherapy Center

丘九望;卢翠婷;曾晓华;陈卓佳;刘韬;梁蔚婷;
QIU Jiuwang;LU Cuiting;ZENG Xiaohua;CHEN Zhuojia;LIU Tao;LIANG Weiting;Pharmacy of Sun Yat-Sen University Cancer Center/State Key Laboratory of Oncology in South China/Collaborative Innovation Center for Cancer Medicine;

摘要(Abstract):

目的探讨PD-1抑制剂临床应用中联用方案及其用药顺序。方法通过HIS检索某院日间化疗中心PD-1抑制剂(含帕博利珠单抗与纳武利尤单抗)在2018年7~10月的医嘱并查阅病案及相关检验数据,分析患者基本信息和用药医嘱、联合治疗方案及其用药顺序情况。结果 184例患者使用PD-1抑制剂共347治疗人次,患者以男性居多(60.87%),而年龄集中在40~69岁(72.83%),主要分布于内科门诊(42.39%)、妇科门诊(20.11%)和肝胆胰门诊(10.33%),所患疾病主要为肺癌(27.17%)、肝癌(11.41%)与淋巴癌(10.33%)。联合用药方案主要为无联合单药使用(40.76%)、联合化疗(29.89%)和联合抗血管生成药物治疗(15.76%)为主。在60例联合用药方案中,用药顺序数据中53.33%为先使用抗PD-1再使用化疗/抗血管生成药物治疗,而20%为先使用化疗/抗血管生成药物治疗后使用抗PD-1治疗,余下26.67%为联合用药顺序间隔7 d以上。同一天内先使用抗PD-1药物再使用化疗药物/抗血管生成药物治疗不良反应发生率最低(44.44%)。结论临床存在不少超药品说明书用法及不同的用药顺序方案,需更多的临床数据以探讨最佳的联合治疗方法及用药顺序,为肿瘤患者带来更多的获益。
OBJECTIVE To investigate the combined treatment schemes of PD-1 inhibitors in clinical practice and the administration sequences. METHODS Medical records and relevant test data of PD-1 inhibitors(including pembrolizumab and nivolumab)from July to October 2018 in the day-time chemotherapy center of a hospital were searched by HIS.The basic information of the patients and treatment concentration,combined treatment scheme and adverse reactions were analyzed. RESULTS A total of 184 patients with PD-1 inhibitors treated 347 times,in the majority with male patients(60.87%),and focused on the ages of 40 to 69 years(72.83%),mainly distributed in the internal medicine department(42.39%),gynecology clinic(20.11%) and hepatobiliary and pancreatic clinic(10.33%),the disease mainly for lung cancer(27.17%),liver cancer(11.41%) and lymph cancer(10.33%).The combination drugs were mainly used alone without combination(40.76%),combined chemotherapy(29.89%) and combined anti-angiogenesis therapy(15.76%).Among the 60 patients,53.33% were treated first with anti-PD-1 followed by chemotherapy/anti-vascular endothelial factor therapy,while 20% were treated first with chemotherapy/anti-vascular endothelial factor followed by anti-PD-1 therapy,and the remaining 26.67% were treated with the combination for more than 7 days.The incidence of adverse event to the lowest(44.44%) when treated first with anti-PD-1 followed by chemotherapy/anti-vascular endothelial factor therapy in one day. CONCLUSION There are many off-label drug instructions and different drug order schemes in clinical practice.It needs a large amount of clinical data to explore the best combination schemes and administration sequences,so as to bring more benefits to tumor patients.

关键词(KeyWords): PD-1抑制剂;帕博利珠单抗;纳武利尤单抗;联合方案;用药顺序
PD-1 inhibitors;pembrolizumab;nivolumab;combined treatment scheme;administration sequence

Abstract:

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基金项目(Foundation): 广东省医院药学研究基金(2019YX16)

作者(Author): 丘九望;卢翠婷;曾晓华;陈卓佳;刘韬;梁蔚婷;
QIU Jiuwang;LU Cuiting;ZENG Xiaohua;CHEN Zhuojia;LIU Tao;LIANG Weiting;Pharmacy of Sun Yat-Sen University Cancer Center/State Key Laboratory of Oncology in South China/Collaborative Innovation Center for Cancer Medicine;

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