Goulet Karine, Grignon Sylvain
Department of Psychiatry, Sherbrooke University, Sherbrooke, Que., Canada.
Psychooncology. 2008 May;17(5):512-6. doi: 10.1002/pon.1267.
Despite the frequent use of the antipsychotic medication, clozapine, in chronic treatments of psychiatric patients, there is limited clinical evidence available to guide clinicians in the problematic situation of a chemotherapy-induced blood dyscrasia.
To perform a literature review and add a case report to the available clinical evidence.
We gathered evidence through literature searches on Medline and with the assistance of a medical information specialist from Novartis who searched their internal database. We also report the case of a patient maintained on clozapine treatment despite full-dose chemotherapy (cisplatin and etoposide) for an extensive lung cancer.
The searches returned seven clinically relevant references. These references do not establish a synergistic effect of clozapine and chemotherapy on blood counts. However, it has been shown that clozapine exposure activates common apoptotic pathways shared with anticancer drugs.
Although the meagre clinical evidence precludes drawing any general conclusion as to the safety of maintaining clozapine administration during chemotherapy, it does not point to an obvious worsening of the haematological outcomes.
尽管抗精神病药物氯氮平在精神科患者的长期治疗中经常使用，但在化疗引起的血液系统疾病这一棘手情况下，可供临床医生参考的临床证据有限。
进行文献综述并补充一例病例报告，以丰富现有临床证据。
我们通过检索Medline获取证据，并在诺华公司医学信息专家的协助下检索其内部数据库。我们还报告了一名广泛期肺癌患者在接受全剂量化疗（顺铂和依托泊苷）期间仍持续使用氯氮平治疗的病例。
检索得到7篇具有临床相关性的参考文献。这些参考文献未证实氯氮平和化疗对血细胞计数有协同作用。然而，研究表明氯氮平暴露会激活与抗癌药物共有的常见凋亡途径。
尽管临床证据不足，无法就化疗期间维持氯氮平给药的安全性得出任何一般性结论，但这并未表明血液学结果会明显恶化。
