长春新碱开展治疗药物监测的必要性和可行性

Necessity and feasibility of therapeutic drug monitoring for vincristine

长春新碱通过干扰有丝分裂纺锤体中的微管,抑制肿瘤生长,常应用于急性淋巴细胞白血病、霍奇金和非霍奇金淋巴瘤、肾母细胞瘤等疾病的综合治疗方案.然而,长春新碱患者间个体差异大、治疗窗狭窄,药物不良反应复杂多变,为临床应用带来了挑战.基于体质量或体表面积的传统治疗方案可能导致次优暴露或严重的周围神经病变,实施治疗药物监测(TDM)可以优化治疗剂量,达到最佳治疗效果.本文就长春新碱开展TDM的必要性和可行性进行探讨,以期为临床实施长春新碱的个体化治疗提供参考.

Vincristine restricts tumor growth by interfering with microtubules in the mitotic spindle,and is often used in comprehensive treatment of acute lymphoblastic leukemia,Hodgkin’s and non-Hodgkin’s lymphoma,wilms tumor and other diseases.However,the large individual differences among patients,the narrow treatment window,and complex and variable clinical symptoms of vincristine-induced peripheral neuropathy bring challenges for clinical application.Traditional treatment based on body weight or body surface area may lead to suboptimal exposure or severe peripheral neuropathy.The implementation of therapeutic drug monitoring(TDM)may optimize the treatment dose of vincristine and achieve good effectiveness with minimal toxicity.Therefore,the necessity and feasibility of vincristine personalized treatment based on TDM were summarized,hoping to provide references in clinical practice.