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·药师与药学服务·


          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
                 Δ

                            3
                                    2
          张广全    1, 2* ,鹿 琦 ,燕 丹 ,徐思露 (1.常州市肿瘤医院药事科,江苏 常州 213032;2.江苏省肿瘤医院/
                                            2 #
          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)


          中图分类号  R969.3      文献标志码  A      文章编号  1001-0408(2024)12-1527-06
          DOI  10.6039/j.issn.1001-0408.2024.12.20


          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。
          关键词  蒽环类药物;乳腺癌;甲状腺癌;药学监护;临床药师

          Pharmaceutical  care  of  reactivating  anthracycline  chemotherapy  in  a  patient  with  advanced  breast  cancer
          combined with thyroid cancer
                                     3
                            1, 2
          ZHANG Guangquan ,LU Qi ,YAN Dan ,XU Silu(1.  Dept.  of  Pharmaceutical  Administration,  Changzhou
                                                         2
                                                2
          Cancer  Hospital,  Jiangsu  Changzhou  213032,  China;2.  Dept.  of  Pharmacy,  Jiangsu  Cancer  Hospital/Jiangsu
          Institute  of  Cancer  Research/the  Affiliated  Cancer  Hospital  of  Nanjing  Medical  University,  Nanjing  210009,
          China;3. Dept. of Pharmacy, Xuzhou Cancer Hospital, Jiangsu Xuzhou 221005, China)

          ABSTRACT   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;
             Δ  基金项目 国 家 自 然 科 学 基 金 青 年 科 学 基 金 项 目(No.     the  clinical  pharmacists  assisted  the  doctors  in  reactivating  the
          81703596);常州市科技局科技计划项目(No.CJ20229035)              anthracycline-based  7-cycle  combination  regimen,  during
             *第一作者 主管药师,硕士。研究方向:抗肿瘤临床药学。电话:
                                                             which the patient had no significant cardiac adverse events and
          0519-69807007。E-mail:609139631@qq.com
             # 通信作者 主管药师,硕士。研究方向:抗肿瘤临床药学。E-                  was  repeatedly  evaluated  as  stable.  TSH  decreased  steadily
          mail:jsszlyy_xusilu@sina.com                       after  Levothyroxine  sodium  tablets  were  added,  and  no


          中国药房  2024年第35卷第12期                                              China Pharmacy  2024 Vol. 35  No. 12    · 1527 ·
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