基于指南及专家共识推荐的腹腔灌注化疗药物选择及用药监护

Selection of drugs for intraperitoneal perfusion chemotherapy and medication monitoring based on recommendations of guidelines and expert consensus

目的汇总腹腔灌注化疗相关指南及专家共识的推荐意见,为肿瘤患者腹腔灌注化疗的药物选择及用药监护提供依据和参考。方法通过检索中英文数据库、指南和协会网站,收集抗肿瘤药物腹腔灌注的相关指南及专家共识等,并对药物选择、用法用量、适应证、溶媒选择、不良反应处理等信息进行汇总与分析。结果检索到腹腔灌注化疗国内外相关指南及专家共识等共20篇,推荐14种化疗药物,每种药物用于腹腔灌注化疗的适应证和用药方案及注意事项各有不同;不同指南和专家共识对药物应用的推荐项目信息亦不相同;对药物推荐依据的证据级别普遍不高;但随着循证证据的增加,近年来的指南和专家共识对药物的推荐循证证据级别逐步提高。结论腹腔灌注化疗在某些癌症治疗中有特殊的优势,临床应用较广,但药物的使用均为超说明书用药,应遵循指南来规范用药和治疗。鉴于目前指南推荐的证据级别普遍不高,且有较多的药物相关问题,仍需更多高质量的临床试验研究,为肿瘤患者腹腔灌注化疗提供更多的循证证据,并形成高质量的指南推荐意见。

Objective To provide basis and reference for drug selection and pharmaceutical care of intraperitoneal perfusion chemotherapy for cancer patients by analyzing and summarizing the relevant guidelines and expert consensus on drug recommendations.Methods Relevant guidelines and expert consensus on intraperitoneal perfusion of anti-tumor drugs were collected by searching Chinese and English databases,guidelines,and association websites.The information on drug selection,dosage,indications,solvent selection,and adverse reaction management was summarized and analyzed.Results Totally 20 domestic and international guidelines and expert consensus on intraperitoneal infusion chemotherapy were retrieved,and 14 chemotherapy drugs were recommended,each of which was with different indications,medication plans,and precautions for intraperitoneal perfusion chemotherapy.The recommended item information for drug application varied among different guidelines and expert consensus.The level of evidence for drug recommendations was generally not high,but with the increase of evidence-based evidence,the level of evidence-based recommendations for drugs in guidelines and expert consensus had gradually increased in recent years.Conclusion Intraperitoneal perfusion chemotherapy has special advantages in the treatment of certain cancers and is widely used in clinical practice.However,the medication is off-label drug use,so the guidelines should be followed to standardize the medication and treatment.Given that the level of evidence recommended by the current guidelines is generally not high and there are many drug-related issues,more high-quality clinical trials are still needed to provide more evidence-based evidence for intraperitoneal perfusion chemotherapy for cancer patients and to form high-quality guidelines for recommendations.