1例妊娠期乳腺癌术后化疗患者的药学监护

Pharmaceutical care on a patient with gestational breast cancer undergoing postoperative chemotherapy

1例32岁女性患者,因“停经35^(+2)周,右乳癌术后欲化疗”于2019年7月10日入院。停经32+3周时,该患者行右乳切除术,术后病理示浸润性导管癌Ⅱ级伴高级别导管内癌,腋下淋巴结见1枚癌宏转移,免疫组化示Her-2过表达,且ER(-),PR(-)。入院后完善相关检查,医师请临床药师会诊,通过查阅国内外相关文献、指南等资料后临床药师建议:该患者有化疗指征,此时可行化疗,方案为注射用环磷酰胺联合注射用盐酸表柔比星,为减少不良反应的发生风险,适当减少化疗药物的剂量,且给予盐酸格拉司琼注射液预防化疗药物引起的恶心呕吐。化疗期间对母胎进行密切药学监护,孕妇无特殊不适,胎儿无异常情况,化疗结束后予出院。

A 32-year-old female patient was admitted to hospital on July 10th,2019 due to menopause for 35^(+2) weeks and a desire for chemotherapy after surgery for right breast cancer.At 32^(+3)weeks of menopause,she underwent right mastectomy.The postoperative pathology showedⅡgrade invasive ductal carcinoma with high-grade intraductal carcinoma and one positive lymph node in axilla.The immunohistochemical results indicated that human epidermal growth factor receptor 2(Her-2)was overexpressed,estrogen receptor(ER)and progesterone receptor(PR)were negative.After admission,clinical pharmacist was asked for a consultation for this patient.Considered that the patient had indications for chemotherapy,clinical pharmacist suggested giving her cyclophosphamide for injection combined with epirubicin hydrochloride for injection for chemotherapy and granisetron hydrochloride injection to prevent possible nausea and vomiting caused by chemotherapy based on relevant literature and guidelines.And the patient and her fetus were given close pharmaceutical care during the course of chemothrepy.The patient had no special discomfort,and the fetus had no abnormal condition.She was discharged after chemotherapy.