阿帕替尼致血小板减少症

Thrombocytopenia induced by apatinib

1例74岁男性胃体腺癌患者先后接受一线、二线和三线化疗6、8和4个周期,因化疗疗效欠佳,接受阿帕替尼靶向治疗(阿帕替尼750 mg口服、1次/d)。18 d后,患者出现乏力、头晕症状,自行停药。实验室检查示血小板计数(PLT)41×10^(9)/L,诊断:血小板减少症(3级)。立即给予升血小板治疗,PLT恢复至153×10^(9)/L后,将阿帕替尼剂量减至500 mg口服、1次/d。21 d后患者头晕症状复现,同时出现面部水肿,实验室检查示PLT 45×10^(9)/L。考虑血小板减少症与阿帕替尼有关且存在剂量相关性。再次给予升血小板治疗。13 d后,PLT恢复至214×10^(9)/L,采用减量并间歇用药方法,即阿帕替尼250 mg/d、服药3 d停药2 d。此后再未出现血小板减少,患者病情稳定。

A 74‑year‑old male patient with gastric body adenocarcinoma received first‑line,second‑line,and third‑line chemotherapy for 6,8,and 4 cycles,respectively.Because of the poor effect of chemotherapy,the patient received targeted therapy with apatinib(750 mg orally,once daily).Eighteen days later,the patient developed fatigue and dizziness,and stopped the drug by himself.Laboratory test showed that platelet count(PLT)was 41×10^(9)/L.He was diagnosed as having grade 3 thrombocytopenia.Platelet‑raising therapy was given immediately.After his PLT returned to 153×10^(9)/L,the dose of apatinib was reduced to 500 mg once daily.Twenty‑one days later,the symptom of dizziness recurred and facial edema appeared.Laboratory test showed that PLT was 45×10^(9)/L.It was considered that thrombocytopenia was related to apatinib and dose‑dependent.Platelet‑raising therapy was given again.Thirteen days later,his PLT returned to 214×10^(9)/L and an intermittent medication method with the reduced dose was applied,that is,taking apatinib 250 mg/d for 3 days and stopping for 2 days.After that,thrombocytopenia did not recur and the patient kept in stable condition.