小分子靶向药物在晚期非小细胞肺癌治疗中的应用合理性评价

Evaluation of the rationality of small molecule targeted therapy in the treatment of advanced non-small cell lung cancer

目的评价医院采用小分子靶向药物在晚期非小细胞肺癌治疗中的应用合理性,为临床合理用药提供依据。方法收集2021年1—12月于新疆医科大学第一附属医院收治的采用小分子靶向药物治疗的晚期非小细胞肺癌患者病例资料,根据药品说明书、《新型抗肿瘤药物临床应用指导原则(2020年版)》、临床诊疗指南等评价用药合理性。结果94例患者共使用小分子靶向药物136例次,共应用小分子靶向药物11种,总体使用频次中奥希替尼片使用频次最高(19.12%);科室分布中以肿瘤科和呼吸科用药患者最多,肿瘤科使用安罗替尼比例最高(29.31%),呼吸科使用阿美替尼、埃克替尼比例最高(均为23.33%);2021年全院小分子靶向药物中,用药频度位于前3位的分别为奥希替尼、吉非替尼、安罗替尼;限定日费用位于前3位的分别为阿来替尼、克唑替尼、塞瑞替尼;11种药物中,4种药物排序比>1,2种药物排序比=1,5种药物排序比<1;根据小分子靶向药物点评细则,对药物应用合理性进行评价。共发现用药不适宜33例次,超说明书用药2例次。结论对于小分子靶向药物用于晚期NSCLC治疗中,医院在药物选择、剂量、联合用药、超说明书使用等方面存在问题。临床工作中医师应及时与患者、药师、护士进行沟通,不断优化肿瘤患者的治疗方案。同时,医院应建立健全管理制度,不断规范临床用药,为患者安全、有效、合理用药提供保障。

Objective To assess the rationality of employing small molecule targeted therapy in the treatment of advanced non-small cell lung cancer in hospitals,providing evidence for the appropriate use of medication in clinical practice.Methods The author collected medical records of patients with advanced non-small cell lung cancer who received small molecule targeted therapy at the First Affiliated Hospital of Xinjiang Medical University from January to December 2021.The rationality of their medication was evaluated based on the drug instructions,Guiding Principles for the Clinical Application of Novel Anti-tumor Drugs(2020 Edition),clinical treatment guidelines,and other relevant references.Results The study included 94 patients,involving a total of 136 instances of the use of 11 different small molecule targeted drugs.Among them,the overall frequency of usage was highest for osimertinib tablets(19.12%).In terms of department distribution,the use of small molecule targeted drugs was most prominent in the oncology and respiratory departments.Within the oncology department,the highest proportion of patients used anlotinib(29.31%),while in the respiratory department,the highest proportions were observed for osimertinib and alectinib(both at 23.33%).In 2021,among all small molecule targeted drugs used in the hospital,the top three drugs in terms of frequency of use were osimertinib,gefitinib,and anlotinib.The top three drugs based on DDDc were alatinib,crizotinib,and ceritinib.Among the 11 drugs,four had a sorting ratio greater than 1,two had a sorting ratio equal to 1,and five had a sorting ratio less than 1.Referring to the guidelines for small molecule targeted drug evaluation,an assessment was conducted on the rationality of drug application.A total of 33 instances of inappropriate medication and 2 instances of off-label drug were identified.Conclusion The hospital faces challenges in the use of small molecule targeted drugs for the treatment of advanced NSCLC,including issues related to drug selection,dosage,combination therapy,and off-label use.In clinical practice,physicians should engage in timely communication with patients,pharmacists,and nurses to constantly optimize the cancer treatment plans for patients.Additionally,the hospital should establish a sound management system to ensure the standardization of clinical medication practices,thus providing a guarantee for the safe,effective,and rational use of medications for patients.