Garrison Julie A, McCune Jeannine S, Livingston Robert B, Linden Hannah M, Gralow Julie R, Ellis Georgiana K, West Howard L
Department of Pharmacy, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington, USA.
Oncology (Williston Park). 2003 Feb;17(2):271-7; discussion 281-2, 286-8.
Paclitaxel-induced myalgias and arthralgias occur in a significant fraction of patients receiving therapy with this taxane, potentially impairing physical function and quality of life. Paclitaxel-induced myalgias and arthralgias are related to individual doses; associations with the cumulative dose and infusion duration are less clear. Identification of risk factors for myalgias and arthralgias could distinguish a group of patients at greater risk, leading to minimization of myalgias and arthralgias through the use of preventive therapies. Optimal pharmacologic treatment and possibilities for the prevention of myalgias and arthralgias associated with paclitaxel are unclear, partially due to the small number of patients treated with any one medication. The effectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs) is the most frequently documented pharmacologic intervention, although no clear choice exists for patients who fail to respond to NSAIDs. However, the increasing use of weekly paclitaxel could necessitate daily administration of NSAIDs for myalgias and arthralgias and leave patients at risk for adverse effects. This concern may also limit the use of corticosteroids for the prevention and treatment of paclitaxel-induced myalgias and arthralgias. Data from case reports suggest that gabapentin (Neurontin), glutamine, and, potentially, antihistamines (e.g., fexofenadine [Allegra]) could be used to treat and/or prevent myalgias and arthralgias. Given the safety profile of these medications, considerable enthusiasm exists for evaluating their effectiveness in the prevention and treatment of paclitaxel myalgias and arthralgias, particularly in the setting of weekly paclitaxel administration.
接受紫杉烷类药物治疗的患者中，有相当一部分会出现紫杉醇引起的肌痛和关节痛，这可能会损害身体功能和生活质量。紫杉醇引起的肌痛和关节痛与单次剂量有关；与累积剂量和输注持续时间的关联尚不清楚。识别肌痛和关节痛的危险因素可以区分出一组风险较高的患者，从而通过使用预防性治疗来尽量减少肌痛和关节痛。与紫杉醇相关的肌痛和关节痛的最佳药物治疗以及预防方法尚不清楚，部分原因是接受任何一种药物治疗的患者数量较少。非甾体抗炎药（NSAIDs）的有效性是最常记录的药物干预措施，尽管对于对NSAIDs无反应的患者没有明确的选择。然而，每周使用紫杉醇的情况越来越多，这可能需要每天使用NSAIDs来治疗肌痛和关节痛，使患者面临不良反应的风险。这种担忧也可能限制皮质类固醇在预防和治疗紫杉醇引起的肌痛和关节痛中的使用。病例报告数据表明，加巴喷丁（Neurontin）、谷氨酰胺以及可能的抗组胺药（如非索非那定[Allegra]）可用于治疗和/或预防肌痛和关节痛。鉴于这些药物的安全性，人们对评估它们在预防和治疗紫杉醇引起的肌痛和关节痛方面的有效性抱有很大热情，特别是在每周使用紫杉醇的情况下。
