乳腺癌术后骨转移患者入组T-DM1临床研究致血小板下降的治疗及护理:1例病例报告及文献复习

Treatment and nursing of thrombocytopenia caused by T-DM1 clinical research in breast cancer patients with bone metastasis:A case report and literature review

目的:通过报道1例乳腺癌术后骨转移患者入组T-DM1(ado-trastuzumab emtansine)临床研究致血小板下降的治疗和护理方法,分享该临床研究的护理方法和经验,为T-DM1治疗中不良反应的处理提供参考。方法:回顾总结参加"T-DM1在中国既往接受过以曲妥珠单抗为基础治疗、局部晚期、不可手术切除或转移性人表皮生长因子受体2(human epidermal growth factor receptor 2,HER2)阳性乳腺癌患者中药代动力学和安全性"Ⅰ期临床研究的1例发生T-DM1相关血小板下降伴出血患者的诊治和个体化护理过程及经验。结果:经积极止血、对症处理、落实护理措施后,患者的症状和指标逐步恢复,血小板缓慢恢复至Ⅲ度,继续采用了促进血小板生成的第2代血小板生成素受体激动剂(thrombopoietin-receptor agonists,TPO-RA)艾曲波帕维持治疗,随访结果良好。结论:该患者的诊治及护理经验,有助于指导国内T-DM1临床试验和临床实践中相关不良应的处置。

Objective:To provide a reference for the treatment of adverse reactions in ado-trastuzumab emtansine(T-DM1)by sharing the nursing measures and experiences in clinical trial,reporting treatment and nursing where thrombocytopenia was caused in a case of bone metastasis after breast cancer surgery in the T-DM1 clinical trial.Methods:By reviewing and summarizing experiences of the diagnostic and treatment on a patient having T-DM1 related thrombocytopenia accompanied by bleeding,who participated in the phaseⅠclinical trial of’Pharmacokinetics and Safety of T-DM1 Among Patients in China Who Have Previously Received Trastuzumab-based Therapy,Who Were Locally Advanced,Who Were in Non-surgical Resection or Who Got Metastatic HER2 Positive Breast Cancer’.Results:By effective hemostasis,symptomatic treatment,and implementation of nursing measures,the patient’s symptoms and complications gradually recovered.The platelets slowly recovered to gradeⅢ,and patients had been being maintenance treated by thrombopoietin-receptor agonists(TPO-RA)Ertripopra and the follow up result was favorable.Conclusion:The experience in the treatment and nursing on the patient is helpful to guide the treatment of related adverse reactions in domestic T-DM1 clinical trials and clinical practice.