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表皮生长因子受体酪氨酸激酶抑制剂所致腹泻的管理

Management of diarrhea induced by epidermal growth factor receptor tyrosine kinase inhibitors.

作者信息

Hirsh V, Blais N, Burkes R, Verma S, Croitoru K

机构信息

Hematology-Oncology Services, Santa Cabrini Hospital, and Department of Oncology, Faculty of Medicine, McGill University, Montreal, QC.

Department of Medicine, University of Montreal, Montreal, QC.

出版信息

Curr Oncol. 2014 Dec;21(6):329-36. doi: 10.3747/co.21.2241.

Abstract

Treatment for non-small-cell lung cancer (nsclc) is moving away from traditional chemotherapy toward personalized medicine. The reversible tyrosine kinase inhibitors (tkis) erlotinib and gefitinib were developed to target the epidermal growth factor receptor (egfr). Afatinib, an irreversible ErbB family blocker, was developed to block egfr (ErbB1), human epidermal growth factor receptor 2 (ErbB2), and ErbB4 signalling, and transphosphorylation of ErbB3. All of the foregoing agents are efficacious in treating nsclc, and their adverse event profile is different from that of chemotherapy. Two of the most common adverse events with egfr tkis are rash and diarrhea. Here, we focus on diarrhea. The key to successful management of diarrhea is to treat early and aggressively using patient education, diet, and antidiarrheal medications such as loperamide. We also present strategies for the effective assessment and management of egfr tki-induced diarrhea.

摘要

非小细胞肺癌(NSCLC)的治疗正从传统化疗转向个性化医疗。可逆性酪氨酸激酶抑制剂(TKIs)厄洛替尼和吉非替尼是针对表皮生长因子受体(EGFR)研发的。阿法替尼是一种不可逆的ErbB家族阻滞剂,用于阻断EGFR(ErbB1)、人表皮生长因子受体2(ErbB2)和ErbB4信号传导以及ErbB3的转磷酸化。上述所有药物在治疗NSCLC方面均有效,且它们的不良事件谱与化疗不同。EGFR TKIs最常见的两种不良事件是皮疹和腹泻。在此,我们重点关注腹泻。成功管理腹泻的关键是通过患者教育、饮食和使用洛哌丁胺等止泻药物进行早期积极治疗。我们还介绍了有效评估和管理EGFR TKI引起的腹泻的策略。

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