今日药学

2017, v.27(11) 771-774

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1例UGT1A1基因突变结肠癌患者应用伊立替康的用药监护
Pharmaceutical Care for One Colon Cancer Patients with UGT1A1 Gene Mutations treated with Irinotecan

王晓刚;陈永康;殷启霖;吴正平;
WANG Xiaogang;CHEN Yongkang;YIN Qilin;WU Zhengping;Chemistry and Biological Engineering College of Yichun University;School of Medical of Nanchang University;

摘要(Abstract):

目的探讨UGT1A1基因多态性对伊立替康化疗患者的安全性及临床药师监护对抗肿瘤药物用药安全性的作用。方法介绍并分析1例UGT1A1基因突变结肠癌患者的诊疗资料。结果拟给予该患者伊立替康320 mg化疗,临床药师根据患者UGT1A1*6纯合突变并结合相关文献报道,推测其发生腹泻或中性粒细胞减少的可能性较高,建议伊立替康减量化疗,于化疗后第13天出现I度骨髓抑制,给予粒细胞集落刺激因子治疗,其后患者血象逐渐恢复,好转出院。结论 UGT1A1基因纯合突变或杂合突变导致UGT1A1对SN-38的代谢能力减弱,导致伊立替康剂量依赖性毒性,临床上UGT1A1基因突变患者,建议伊立替康减量化疗。临床药师应依据药物代谢酶基因多态性基本理论并结合患者实际情况制定个体化、合理化的用药及监护方案,从而确保患者用药安全、有效。
OBJECTIVE To investigate the influence of UGT1 A1 gene polymorphism on the safety of irinotecan chemotherapy,and the role of clinical pharmacists in monitoring the safety of antineoplastic drugs. METHODS One case of colon cancer with UGT1 A1 mutation was introduced and analyzed. RESULTS One colon cancer patient with UGT1 A1 gene mutation intended to use irinotecan 320 mg chemotherapy. Considering the patient UGT1 A1 * 6 homozygous mutation and the relevant literature reported,the clinical pharmacists recommended a low dose of irinotecan for the high risk of diarrhea and neutropenia. In the first 13 days after chemotherapy,low degree of bone marrow suppression was occurred. The blood gradually restored after given granulocyte colony stimulating factor. CONCLUSION Homozygous mutations or heterozygous mutations in the UGT1 A1 gene lead to a decrease in the metabolic capacity of UGT1 A1 to SN-38,resulting in dose dependent toxicity of irinotecan. Reduction dose of irinotecan is recommended for patients with UGT1 A1 mutations in clinical practice. Clinical pharmacists should formulate individualized and rational drug use according to the basic theory of drug metabolizing enzyme gene polymorphism and the actual situation of patients,so as to ensure the safety and effectiveness of medication.

关键词(KeyWords): 伊立替康;UGT1A1;骨髓抑制;用药监护
irinotecan;UGT1A1;bone marrow suppression;medication monitoring

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作者(Author): 王晓刚;陈永康;殷启霖;吴正平;
WANG Xiaogang;CHEN Yongkang;YIN Qilin;WU Zhengping;Chemistry and Biological Engineering College of Yichun University;School of Medical of Nanchang University;

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