临床药师参与1例纳武利尤单抗致棘皮瘤的处置与分析

宋霞; 鱼丽莉; 赵慧

doi:10.6039/j.issn.1001-0408.2023.02.21

您当前的位置：

首页 >

文章列表页 >

临床药师参与1例纳武利尤单抗致棘皮瘤的处置与分析

药师与药学服务 | 更新时间：2023-02-22

- 临床药师参与1例纳武利尤单抗致棘皮瘤的处置与分析
- Practice and analysis of clinical pharmacist participating in the treatment of a case of acanthoma caused by navulizumab
- 中国药房 2023年34卷第2期页码：237-241
- 作者机构：
  
  1.兰州大学第二医院药剂科，兰州　730030
  2.兰州大学第二医院肿瘤内科，兰州　730030
- 作者简介：
  
  副主任药师，硕士。研究方向：临床药学、循证药学。E-mail：qiuyezisongxia@163.com
  主任中药师。研究方向：临床药学、医院药学。E-mail：ldeyzh@163.com
- 基金信息：
  
  甘肃省自然科学基金资助项目(22JR5RA991)
- DOI：10.6039/j.issn.1001-0408.2023.02.21
  中图分类号： R969.3
- 纸质出版日期：2023-01-30，
  
  收稿日期：2022-10-26，
  
  修回日期：2022-12-28，
扫描看全文
宋霞,鱼丽莉,赵慧.临床药师参与1例纳武利尤单抗致棘皮瘤的处置与分析[J].中国药房,2023,34(02):237-241.

SONG Xia,YU Lili,ZHAO Hui.Practice and analysis of clinical pharmacist participating in the treatment of a case of acanthoma caused by navulizumab[J].ZHONGGUO YAOFANG,2023,34(02):237-241.
宋霞,鱼丽莉,赵慧.临床药师参与1例纳武利尤单抗致棘皮瘤的处置与分析[J].中国药房,2023,34(02):237-241. DOI： 10.6039/j.issn.1001-0408.2023.02.21.

SONG Xia,YU Lili,ZHAO Hui.Practice and analysis of clinical pharmacist participating in the treatment of a case of acanthoma caused by navulizumab[J].ZHONGGUO YAOFANG,2023,34(02):237-241. DOI： 10.6039/j.issn.1001-0408.2023.02.21.

摘要

本文报道了临床药师参与的1例纳武利尤单抗致棘皮瘤患者的诊治过程。该例患者使用纳武利尤单抗2周后发生棘皮瘤，累及头皮、颈部、躯干、手背、脚底等部位，并伴有中度瘙痒，经临床药师按照不良反应因果关系评价方法判定为“肯定”。临床药师查阅文献发现，免疫检查点抑制剂致棘皮瘤以男性、高龄、恶性黑色素瘤患者多见，好发于躯干、四肢及手部，局部手术及糖皮质激素治疗是主要的处置手段。临床药师在考虑治疗药物有效性、安全性、经济性、可及性的基础上，最大限度尊重患者意愿，与医师讨论后决定予患者卤米松乳膏外用+维A酸胶囊口服+依巴斯汀片口服的综合治疗方案，并予患者继续使用纳武利尤单抗行免疫治疗，同时由临床药师进行药学监护和心理疏导。最终，该例患者顺利完成治疗，棘皮瘤在纳武利尤单抗治疗结束后逐渐消退。该例患者的诊治过程表明，临床药师的参与有助于提高患者免疫治疗的连续性与安全性。

Abstract

This paper reports the clinical pharmacist participated in the diagnosis and treatment of a patient with acanthoma caused by nivolumab. This patient developed acanthoma 2 weeks after medication， involving scalp， neck， trunk， back of hand， sole of foot and other parts， with moderate pruritus. The clinical pharmacist determined it as “yes” according to the causality evaluation method of adverse reactions. After reviewing the literature， clinical pharmacists found that acanthoma caused by immune checkpoint inhibitors was more commonly seen in male elderly patients with malignant melanoma， and mainly involved the trunk， extremities and hands. Under the general principle of considering the effectiveness， safety， economy and accessibility of therapeutic drugs， the clinical pharmacist finally decided to give the patient a comprehensive treatment scheme of Halometasone cream for external use + oral administration of Retinoic acid capsules + oral administration of Ebastine tablets after discussion with the doctor， with maximum respect for the patient’s wishes，and continued to use navulizumab for immunotherapy. At the same time， pharmaceutical care and psychological counseling were conducted by clinical pharmacist. Finally， the patient successfully completed the treatment， and the acanthoma gradually subsided after the end of navulizumab treatment. The diagnosis and treatment process of this patient indicated that the participation of clinical pharmacists is helpful to improve the continuity and safety of immunotherapy.

关键词

纳武利尤单抗棘皮瘤皮肤免疫相关不良反应临床药师预后

Keywords

acanthomacutaneous immune-related adverse eventsclinical pharmacistprognosis

references

VILLADOLID J，AMIN A. Immune checkpoint inhibitors in clinical practice：update on management of immune-related toxicities[J]. Transl Lung Cancer Res，2015，4（5）：560-575.

CURRY J L，TETZLAFF M T，NAGARAJAN P，et al. Diverse types of dermatologic toxicities from immune checkpoint blockade therapy[J]. J Cutan Pathol，2017，44（2）：158-176.

GLEICH T，CHITICARIU E，HUBER M，et al. Keratoacanthoma： a distinct entity[J]. Exp Dermatol，2016，25（2）：85-91.

BHARDWAJ M，CHIU M N，PILKHWAL SAH S. Adverse cutaneous toxicities by PD-1/PD-L1 immune checkpoint inhibitors：pathogenesis，treatment，and surveillance[J]. Cutan Ocul Toxicol，2022，41（1）：73-90.

FABIANO A，CALZAVARA-PINTON P，MONARI P，et al.Eruptive squamous cell carcinomas with keratoa-canthoma-like features in a patient treated with ruxolitinib[J].Br J Dermatol ，2015，173（4）：1098-1099.

ARNAULT J P，WECHSLER J，ESCUDIER B，et al. Keratoacanthomas and squamous cell carcinomas in patients receiving sorafenib[J]. J Clin Oncol，2009，27（23）：e59-e61.

国家食品药品监督管理局药品安全监管司，国家药品不良反应监测中心.药品不良反应报告和监测管理办法：卫生部令第81号[EB/OL].（2011-05-24）[2020-11-10].http://www.gov.cn/zhengce/2011-05/24/content_2603398.htmhttp://www.gov.cn/zhengce/2011-05/24/content_2603398.htm.

PRETI B T B，PENCZ A，COWGER J J M，et al. Skin deep：a fascinating case report of immunotherapy-triggered，treatment-refractory autoimmune lichen planus and keratoacanthoma[J]. Case Rep Oncol，2021，14（2）：1189-1193.

中华医学会皮肤性病学分会皮肤肿瘤研究中心，中国医师协会皮肤科医师分会皮肤肿瘤学组.皮肤鳞状细胞癌诊疗专家共识：2021[J].中华皮肤科杂志，2021，54（8）：653-664.

CROW L D，PERKINS I，TWIGG A R，et al. Treatment of PD-1/PD-L1 inhibitor-induced dermatitis resolves concomitant eruptive keratoacanthomas[J]. JAMA Dermatol，2020，156（5）：598-600.

FUJIMURA T，LYU C，TSUKADA A，et al. Eruptive keratoacanthoma with spontaneous regression arising from a cervical squamous cell carcinoma patient treated with nivolumab[J]. J Dermatol，2019，46（5）：e177-e178.

FRADET M，SIBAUD V，TOURNIER E，et al. Multiple keratoacanthoma-like lesions in a patient treated with pembrolizumab[J]. Acta Derm Venereol，2019，99（13）：1301-1302.

ANTONOV N K，NAIR K G，HALASZ C L. Transient eruptive keratoacanthomas associated with nivolumab[J]. JAAD Case Rep，2019，5（4）：342-345.

FELDSTEIN S I，PATEL F，LARSEN L，et al. Eruptive keratoacanthomas arising in the setting of lichenoid toxi-city after programmed cell death 1 inhibition with ni-volumab[J]. J Eur Acad Dermatol Venereol，2018，32（2）：e58-e59.

BEDNAREK R，MARKS K，LIN G. Eruptive keratoacanthomas secondary to nivolumab immunotherapy[J]. Int J Dermatol，2018，57（3）：e28-e29.

FREITES-MARTINEZ A，KWONG B Y，RIEGER K E，et al. Eruptive keratoacanthomas associated with pembrolizumab therapy[J]. JAMA Dermatol，2017，153（7）：694-697.

CHAUDHARI S，LEON A，LEVIN E，et al. Case report of multiple keratoacanthomas and squamous cell carcinomas in a patient receiving pembrolizumab[J]. J Drugs Dermatol，2017，16（5）：513-515.

BANDINO J P，PERRY D M，CLARKE C E，et al. Two cases of anti-programmed cell death 1-associated bullous pemphigoid-like disease and eruptive keratoacanthomas featuring combined histopathology[J]. J Eur Acad Dermatol Venereol，2017，31（8）：e378-e380.

SCHWARTZ R A. Keratoacanthoma[J]. J Am Acad Dermatol，1994，30（1）：1-19.

浏览量

下载量

CSCD

文章被引用时，请邮件提醒。

提交

工具集

关联资源

曲妥珠单抗联合术前辅助化疗用于Her-2阳性乳腺癌的临床观察

XPC基因单核苷酸多态性与肺癌相关性的研究进展

沙库巴曲缬沙坦钠对急性前壁心肌梗死合并急性心功能不全患者短期预后的影响

复方丹参滴丸对经皮冠状动脉介入治疗术后对比剂肾病及患者预后的影响

中国人群药物致急性肾损伤的系统评价