从1例溃疡型胃癌患者上消化道出血探讨抗血管生成药物的安全应用

Discussion on security application of antiangiogenic agents from upper gastrointestinal bleeding in a patient with ulcer-gastric carcinoma

1例56岁溃疡型胃癌男性患者,因确诊"胃腺癌腹膜后淋巴结转移多发肝转移1年6个月余"入院。该患者既往行多周期化疗,治疗进展后给予阿帕替尼850 mg,qd治疗,并于化疗第1、7日腹腔灌注贝伐珠单抗100 mg。第8日患者发生上消化道出血,总量约1000 m L,遂停用阿帕替尼,同时给予抑酸、止血及输血等对症治疗,患者病情好转。临床药师结合相关文献,探讨抗血管生成药物在溃疡型胃癌患者中的用药风险,建议临床在应用抗血管生成药物时应充分考虑患者出血风险;对于高出血风险患者应慎用抗血管生成药物,尤其慎用2种或以上抗血管生成药物。

One 56-year-old male patient was hospitalized for gastric adenocarcinoma with liver and lymph node metastases for more than 1.5 years. The patient had received 16 periods of chemotherapy, observed as progressive disease （PD）. After administration of apatinib （850 mg, qd） for a month, the patient developed stable disease （SD）. For the current chemotherapy, apart from apatinib, bevacizumab was peritoneal perfused at the 1st and 7th day to control malignant hydroperitoneum. However, on the 8th day, upper gastrointestinal hemorrhage appeared and the apatinib or bevacizumab treatment was stopped. Patient was accordingly treated with acid suppression, as well as emergent intervention of hemostasis and transfusion. Subsequently, clinical symptoms were markedly improved. Clinical pharmacists discussed the bleeding tendency and prevention measures of antiangiogenic agents on ulcer-gastric carcinoma patients according to the current report and references. It was suggested that： bleeding tendency merit close attention when using antiangiogenic agents; patients with high bleeding tendency should be prudent to use antiangiogenic agents, especially for 2 or more kinds of antiangiogenic agents.