临床药师参与制定1例乙肝病毒携带者合并晚期肺腺癌的治疗方案

Clinical pharmacist involved in treatment of a patient with hepatitis B virus and advanced lung adenocarcinoma

1例62岁中老年男性因"咳嗽、咳痰2年余,胸痛10 d"入院,诊断右肺腺癌晚期。临床医生拟给予PP方案(培美曲塞二钠0.8 g d1+顺铂130 mg d1)化疗。药师发现患者为HBs Ag阳性患者(乙肝小三阳),考虑到化疗可能会导致乙肝病毒再激活,建议在化疗同时予以抗乙肝病毒治疗,根据抗病毒药物的特点,建议选用耐药性低的恩替卡韦。医生采纳了临床药师的建议,化疗期间及出院后口服恩替卡韦(0.5 mg,qd)。最终患者顺利完成化疗,随访肝功能正常。

A 62-year-old man was hospitalized due to cough and sputum for more than 2 years and chest pain 10 days. According to the pathological results of bronchoscopic biopsy, right lung adenocarcinoma was clearly diagnosed. The clinician intended to give the patient chemotherapy of PP regimen（pemetrexed disodium 0.8 g d1 ＋ cisplatin 130 mg d1）. The pharmacist, considering the patient was a HBV carrier and chemotherapy may lead to HBV reactivation, recommended to give anti-HBV therapy during the whole chemotherapy by consulting literature. According to the characteristics of anti-HBV drugs, entecavir was preferred. The clinician adopted this suggestion and prescribed entecavir（0.5 mg, po, qd）. Finally, the patient successfully completed chemotherapy and was discharged.