索坦治疗晚期肾癌的毒副反应及防治措施

Sutent in treating advanced renal cell carcinoma:toxicity profile and management

目的探讨索坦治疗晚期肾癌的毒副反应特点和相应处理方法。方法索坦治疗晚期转移性肾癌患者25例,男性18例,女性7例,平均年龄48.6岁(36～78岁)。18例口服索坦50mg每日1次,4/2方案(服药4周停用2周),7例口服索坦37.5mg每日1次,连续服用。观察评估治疗中所出现的毒副反应及其相应的处理方法。结果Ⅱ级以上的不良反应发生率分别为手足综合征68%(17/25),骨髓抑制68%(17/25),皮疹12%(3/25),口腔黏膜炎56%(14/25),高血压16%(4/25),疲劳乏力64%(16/25)。各种毒副反应出现的时间不同,但其中95%出现在服药半年内。共有20%患者(5/25)因出现Ⅲ级毒副反应而行治疗药物减量(主要是手足综合征和骨髓抑制),1例患者永久性停药(纳差,放弃治疗)。结论索坦治疗国内晚期肾癌患者所产生的常见的不良反应发生率绝大多数与国外报道略有不同,但通过严格随访,积极预防及对症处理,服药后安全性良好。

Objective To investigate the characteristics of toxicities of Sutent in treating advanced renal cell carcinoma,and discuss the management for those toxicities. Methods 25 patients with advanced renal cell carcinoma were treated with Sutent. 18 cases were male,7 were female,with the average age of 48.6 years（36-78）. Single agent of Sutent 50 mg once daily was administrated to 18 patients,4 week on/ 2 week off,and the other 7 patients were given Sutent 37.5 mg once daily without stop. The main toxicities such as hand foot syndrome, alopecia, rash, mucositis, fatigue, diar rhea, weight loss, hypertension, hemoptysis, anemia, et al, were analyzed for their occurrence time, du ration,and grade. Results The toxicities of Sutent included hand foot skin reaction （68 %）,blood/ bone marrow（68%）,rash （12%）,mucositis （56%）,hypertension （16%）,fatigue （64%）. Most of the toxicities appeared in the first half year of treatment. 5 cases （20%） experienced grade 3 toxicities and had dose reduced;and 1 patient had permanent dose withdraw. Conclusions Most of the toxici ties of Sutent were different between Chinese patients and foreigner. Careful monitor,active preven tion and management,most of the toxicity of Sutent were easy to manage.