恩沙替尼、安罗替尼、培美曲塞、唑来膦酸联用致重度贫血1例

A case of severe anemia induced by ensartinib,anlotinib,pemetrexed and zoledronic acid

1例42岁男性Ⅳ期右肺腺癌患者,病史9年,既往曾予多种化疗和靶向药物,因疾病进展,靶向治疗调整为盐酸恩沙替尼胶囊,联合安罗替尼、培美曲塞二钠和唑来膦酸抗肿瘤治疗。患者连续服用恩沙替尼胶囊82 d后,无明显诱因突发乏力,血红蛋白从用药前的132 g·L^(-1)降至59 g·L^(-1),确诊为重度贫血,考虑与恩沙替尼、安罗替尼、培美曲塞以及唑来膦酸相关,不良反应关联性评价为“可能”。经停药、对症支持治疗后,入院第6天血红蛋白恢复至97 g·L^(-1)。恩沙替尼在我国上市时间较短,出现重度贫血的相关报道较少。该病例提示临床治疗中应重点关注使用经验较为有限的药物,及时发现其少见的不良反应。

A 42-year-old male patient with stage IV right lung adenocarcinoma was diagnosed for 9 years,and he was treated with multiple chemotherapy and targeted drugs.Due to disease progression,the targeted therapy was adjusted to ensartinib hydrochloride capsules combined with anlotinib,pemetrexed disodium and zoledronic acid.After 82 days of continuous administration of ensartinib,the patient had sudden fatigue without obvious inducement,and the hemoglobin decreased from 132 g·L^(-1)before the administration of ensartinib to 59 g·L^(-1).The patient was diagnosed as severe anemia,which was considered to be related to ensartinib,anlotinib,pemetrexed and zoledronic acid,and the association of adverse reactions was evaluated as"possible".After drug withdrawal and symptomatic support treatment,the hemoglobin recovered to 97 g·L^(-1)on the 6th day of admission.Ensartinib has been approved for marketing in China for a short time,and there are few reports of severe anemia.Reminder of this case,key attention should be paid to some drugs with limited use experience in clinical treatment,in order to find some adverse reactions with low incidence.