Goulburn Valley Health, Graham Street, Shepparton 3630, Australia.
BMC Cancer. 2013 Dec 6;13:581. doi: 10.1186/1471-2407-13-581.
Serine-threonine inhibitors, such as vemurafenib, are being used increasingly in cancer treatment, and the toxicity and therapeutic benefit need to be balanced carefully both before and during treatment.
A patient with metastatic melanoma and end stage renal failure who was on peritoneal dialysis was treated with the serine-threonine kinase inhibitor, vemurafenib. After 5 months of treatment, a substantial response to vemurafenib was observed using imaging, but when he developed a prolonged QTc interval (common toxicity criteria (CTC) grade 3), treatment was interrupted. Vemurafenib was restarted at a reduced dose when the QTc interval returned to normal. The patient has had a significant response to vemurafenib and continued on treatment for 12 months after beginning the therapy.
This is the first reported case of end stage renal failure in a patient who is taking vemurafenib. Although the patient developed QTc prolongation, it appears to be asymptomatic, and was managed with dose reduction. This case highlights the need for closer QTc monitoring at the start and during treatment.
丝氨酸-苏氨酸抑制剂，如威罗非尼，在癌症治疗中的应用越来越多，在治疗前和治疗期间都需要仔细平衡毒性和治疗效果。
一名转移性黑色素瘤和终末期肾衰竭患者正在进行腹膜透析，使用丝氨酸-苏氨酸激酶抑制剂威罗非尼进行治疗。治疗 5 个月后，通过影像学观察到威罗非尼有明显的反应，但当他出现较长的 QTc 间期（常见毒性标准（CTC）3 级）时，中断了治疗。当 QTc 间期恢复正常时，威罗非尼以较低剂量重新开始治疗。该患者对威罗非尼有明显的反应，并在开始治疗后 12 个月继续治疗。
这是首例接受威罗非尼治疗的终末期肾衰竭患者的报告病例。尽管该患者出现了 QTc 延长，但似乎无症状，并通过减少剂量进行了管理。该病例强调了在治疗开始和治疗期间需要更密切地监测 QTc。
