奥沙利铂联合含氟或紫杉类化疗方案致药物不良反应的临床分析

Clinical analysis of adverse drug reactions to oxaliplatin combined fluorine-containing or taxanes-containing chemotherapy regimen

目的分析奥沙利铂药物不良反应(ADR)的临床特点和防范策略,为临床合理用药提供依据。方法 2011年1月至2016年12月在本院用奥沙利铂治疗后发生的ADR病例共78例。收集所有病例的临床资料并对其用药后ADR发生时间、化疗方案及治疗周期、发生ADR时奥沙利铂的累积剂量、临床表现、严重程度及应对策略进行归纳分析。结果患者主要涉及结直肠癌、胃癌、宫颈癌、卵巢癌及其他癌症,全部用含奥沙利铂化疗方案。发生ADR的化疗方案有紫杉醇+奥沙利铂(TP方案)、多西他赛+奥沙利铂(DP方案)、奥沙利铂+卡培他滨(XELOX方案)、奥沙利铂+亚叶酸钙+氟尿嘧啶(m FOLFOX6方案)、mFOLFOX6+贝伐单抗方案、在mFOLFOX6方案的基础上加大奥沙利铂剂量的FOLFOX7方案、氟尿嘧啶+奥沙利铂(FP方案)和替吉奥联合奥沙利铂方案,均为含氟或紫杉类化疗方案。其中,mFOLFOX6方案和TP方案发生ADR的比例较高,分别是43.59%和30.77%。奥沙利铂的ADR常发生于用药后的5~30min(53.85%),一般均会在24 h内发生。临床表现以皮肤及其附件损害(36.05%)、呼吸系统损害(27.21%)最为常见。结论奥沙利铂联合含氟或紫杉类化疗方案易发生ADR;用奥沙利铂24 h内、特别是用药的前30 min应密切关注其ADR,发生3~4级ADR者,建议停用奥沙利铂。

Objective To analyze the clinical characteristics and prevention strategy of adverse drug reactions （ADR） caused by oxaliplatin, so as to provide the basis for clinical rational use of drugs. Methods Seventy - eight cases reports of oxaliplatin ADR from January 2011 to December 2016 in our hospital were analyzed retrospectively. The clinical data of all cases including the first onset time, chemotherapy regimens and treatment cyele; cumulative dose of oxaliplatin, clinical manifestations, severity, strategies were collected and analyzed. Results In the patients with eolorectal carcinoma, gastric carcinoma, cervical cancer, ovarian cancer and other malignancies who were administered chemotherapy containing oxaliplatin. Such as taxol and oxaliplatin （TP regimens）, docetaxel and oxaliplafin （DP regimens）, oxaliplatin ＋ eapecitabine （XELOX regimens）, oxaliplatin ＋ leucovorin ＋ fluorouracil （mFOLFOX6 regimens）, mFOLFOX6 plus bevacizumab regimens, oxaliplatin ＋ leucovorin ＋ fluorouracil （ FOLFOX7 regimens）, fluorouracil ＋ oxaliplatin （ FP regimens） and tegafur combined with oxaliplatin regimens for the treatment, all were fluorine - containing or taxanes - containing regimens. The maximum rate of ADR was 43.59% of them treated with mFOLFOX6 regimens and 30. 77% of them treated with TP regimens （containing taxol and oxaliplatin ）, respectively. ADR induced by oxaliplatin usually occurred within 5 -30 rain （53.85%） after drug administration, generally within 2＇$ h. Lesions of skin and its appendants （36. 05% ） and respiratory symptoms（27.21% ） were the most common clinical manifestations. Conclusion Oxaliplatin combined fluorine -containing or taxanes -containing chemotherapy regimens prone to ADR. Colse attention must be paid to the patients who received oxaliplatin within 24 h, especially within 30 min. Patients who experienced a grade 3 -4 ADR are unlikely to tolerate further therapy.