周花萍,曾英彤,陈文颖,杨敏
ZHOU Huaping,ZENG Yingtong,CHEN Wenyin,YANG Min

• 1:广东省人民医院药学部
• 2:中山大学药学院

摘要(Abstract)：

目的调查分析本院乳腺癌患者右丙亚胺(Dexrazone,DEX)的应用状况,促进临床合理用药。方法回顾2013年本院乳腺癌患者使用DEX患者的病历,参照2008年美国肿瘤化疗及放疗保护剂临床操作指南,对其用药指征、用药时机、用药剂量、用药人群等情况进行分析。结果 2013年本院共228例乳腺癌患者使用DEX,其中早期乳腺癌患者占91.14%,31.14%用于预防非蒽环类药物的心脏毒性,首次应用蒽环类药物即给予DEX的比例高达90.44%,仅3.82%的患者使用DEX时蒽环类药物累积剂量大于300 mg/m2。结论临床应用右丙亚胺存在不合理现象,应提高临床医师对DEX的认识,促进临床合理用药。
OBJECTIVE To investigate and analysis the usage of dexrazone in patients with breast cancer in the hospital,and to promote its rational application in the clinic. METHODS The records of breast cancer patients using DEX were reviewed. The medication indication,timing,dosage and crowd in the hospital during 2013 were assessed according to the American Society of Clinical Practice Gudidelines for the Use of Chemotherapy and Radiotherapy protectants 2008. RESULTS A total of 228 cases of malignant breast cancer patients with DEX in the hospital. Of which 91. 14% for early stage breast cancer,31. 14% for the prevention of nonanthracycline cardiotoxicity. Patients received dexrazoxane when given from first dose of anthracycline up to 90. 44%,only 3. 82% of patients using the DEX had received more than 300 mg / m2 of anthracycline. CONCLUSION There are some unreasonable situation in the application of DEX in patients with breast cancer,clinicians should raise awareness of using DEX properly to ensure its safe and effective application.

关键词(KeyWords)： 右丙亚胺;蒽环类药物心脏毒性;乳腺癌;合理用药
Dexrazone;Anthracyclines cardiotoxicity;breast cancer;rationality

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 周花萍,曾英彤,陈文颖,杨敏
ZHOU Huaping,ZENG Yingtong,CHEN Wenyin,YANG Min

参考文献(References)：

• [1]Barry E,Albarez JA,Scully RE,et al.Anthracyline-induced cardiotoxicity:course,pathophysiology,prevention and management[J].Expert Opin Pharmacother,2007,8:1039-1058.
• [2]Lipshultz SE,Alvarez JA,Scully RE.Anthracyline associated cardiotoxicity in survivors of childhood[J].cancer Heart,2008,94:525-533.
• [3]Lipshultz SE,Miller TL,Scully RE,et al.Changes in cardiac biomarkers during doxorubicin treatment of pediatric patients with high risk acute lymphoblastic leukemia associations with long-term echocardiographic outcomes[J].J Clin Oncol,2012,30:1042-1049.
• [4]Lipshultz SE,Lipsitz SR,Sallan SE,et al.Chronic progressive cardiac dysfunction years after doxorubicin therapy for childhood acute lymphoblastic leukemia[J].J Clin Oncol,2005,23:2629-2636.
• [5]van Dalen EC,Caron HN,Dickinson HO,et al.Cardioprotective interventions for cancer patients receiving anthracyclines[J].Cochrane Database Syst Rev,2011,6:CD003917.
• [6]American Society of Clinical Oncology 2008 Clinical Practice Guideline Update:Use of Chemotherapy and Radiation Therapy Protectants[J].J Oncol Pract,2008,11:4(6):277-279.
• [7]Minotti G,Menna P,Salvatorelli E,et al.Anthracyclines:molecular advance and pharmacologic in antitumor activity and cardiotoxicity[J].Pharmacol Rev,2004,56(2):185-229.
• [8]Swain SM,Whaley FS,Gerber MC,et al.Cardioprotection With Dexrazoxane for Doxorubicin-Containing Therapy in Advanced Breast Cancer[J].J Clin Oncol,1997,15(4):1318-1332.
• [9]Speyer JL,Green MD,Zeleniuch-Jacquotte A,et al.ICRF-187permits longer treatment with doxorubicin in women with breast cancer[J].J Clin Oncol,1992,10(1):117-127.
• [10]Venturini M,Michelotti A,Del Mastro L,et al.Multicenter randomized controlled clinical trial to evaluate cardioprotection of dexrazoxane versus no cardioprotection in women receiving epirubicin chemotherapy for advanced breast cancer[J].J Clin Oncol,1996,14(12):3112-3120.
• [11]Barry EV,Vrooman LM,Dahlberg SE,et al.Absence of secondary malignant neoplasms in children with high-risk acute lymphoblastic leukemia treated with dexrazoxane[J].J Clin Oncol,2008,26(7):1106-1111.
• [12]Ganame J,Claus P,Uyttebroeck A,et al.Myocardial dysfunction late after low-dose anthracycline treatment in asymptomatic pediatric patients[J].J Am Soc Echocardioqr,2007,20(12):1351-1358.
• [13]Lipshultz SE,Rifai N,Sallan SE,et al.Predictive value of cardiac troponin T in pediatric patients at risk for myocardial injury[J].Circulation,1997,96(8):2641-2648.
• [14]王培,张晟,张霄蓓.DEX对接受含蒽环类药物化疗乳腺癌患者的心脏保护作用[J].中华肿瘤杂志,2013,35(2);135-139.
• [15]Swain SM.Adult multicenter trials using dexrazoxane to protect against cardiac toxicity[J].Semin Oncol,1998,25(4suppl10):43-47.
• [16]Tebbi CK,London WB,Friedman D,et al.Dexrazoxane-associated risk for acute myeloid leukemia/myelodysplastic syndrome and other second malignancies in pediatric Hodgkin's disease[J].J Clin Oncol,2007,25(5):493-500.
• [17]Swain SM,Whaley FS,Gerber MC,et al.Delayed administration of dexrazoxane provides cardioprotection for patients with advanced breast cancer treated with doxobicin-containing therapy[J].J Clin Oncol,1997,15:1333-1340.
• [18]Bates M,Lieu D,Zagari M,et al.A pharmacoeconomic evaluation of the use of dexrazoxane in preventing anthracycline-induced cardiotoxicity in patients with stage IIIB or IV metastatic breast cancer[J].Clin Ther,1997,19:167-184.
• [19]Marty M,EspiéM,Llombart A,et al.Multicenter randomized phase III study of the cardioprotective effect of dexrazoxane(Cardioxane)in advanced/metastatic breast cancer patients treated with anthracycline-based chemotherapy[J].Ann Oncol,2006,17(4):614-622.
• [20]Lopez M,Vici P,Di Lauro K,et al.Randomized prospective clinical trial of high-dose epirubicin and dexrazoxane in patients with advanced breast cancer and soft tissue sarcomas[J].J Clin Oncol,1998,16(1):86-92.