从1例非小细胞肺癌患者探讨TKI与抑酸药物的相互作用

Study on the interaction between TKI and acid-inhibitory drugs through a non-small cell lung cancer patient

1例62岁女性患者,因"右肺腺癌全身多发转移"入院。入院后行EGFR基因检测,结果为21外显子敏感突变,余未见突变。给予口服EGFR-TKI盐酸厄洛替尼片(150 mg,qd)抗肿瘤治疗,服用第2天因出现胃肠道不适给予奥美拉唑肠溶胶囊(20 mg,qd)对症治疗。临床药师结合相关资料分析了TKI与抑酸药物的相互作用、临床意义及防治措施,并根据现有证据探讨,盐酸厄洛替尼与奥美拉唑可能存在具有临床意义的相互作用,建议将抑酸药物更换为雷尼替丁胶囊(150 mg,bid),并在给药前2 h或给药后10 h给予盐酸厄洛替尼。患者治疗过程顺利,胃肠道反应亦明显减轻。服用盐酸厄洛替尼1个月后再次入院复查,疗效评价为PR。

One 62-year-old female lung cancer patient was hospitalized for right lung adenocarcinoma with multiple metastases. Genetic testing results of the patient showed that EGFR sensitive mutation was in exon 21. Erlotinib （150 mg, qd） was taken for antitumor therapy and omeprazole enteric-coated capsules （20 mg, qd） were taken the next day because of gastrointestinal tract discomfort. Clinical pharmacist analyzed drug interactions, clinical significance and prevention ways between TKI and acid- inhibitory drugs. According to the present related data, we considered that erlotinib and omeprazole have possible clinical significant interaction and recommended omeprazole should be replaced by ranitidine （150 mg, bid）. Erlotinib 150 mg single dose was taken 2 hours before and 10 hours after omeprazole was taken. The treatment of the patient was successful and her gastrointestinal tract reaction was alleviated. Partial response was observed in the patient when erlotinib was taken for one month.