Morimoto Yoshihito, Takei Hidefumi, Tachibana Keisei, Nakazato Yoko, Tanaka Ryota, Nagashima Yasushi, Watanabe Kazuhiro, Seki Reisuke, Shinohara Takao, Kondo Haruhiko
Education and Research Center for Clinical Pharmacy, Showa Pharmaceutical University.
Department of General Thoracic Surgery, Kyorin University School of Medicine.
Yakugaku Zasshi. 2018;138(3):437-442. doi: 10.1248/yakushi.17-00192.
Adjuvant cisplatin-vinorelbine chemotherapy has been shown to be effective in patients with completely resected non-small cell lung cancer (NSCLC) in several Phase III trials, but not yet in the Japanese population. Pharmacists are expected to assist patients with completion of adjuvant chemotherapy. The aim of this retrospective study was to evaluate the compliance with and safety of adjuvant cisplatin-vinorelbine chemotherapy in Japanese patients and to evaluate the contribution of pharmacists to completion of treatment. Thirty-four patients with NSCLC who received adjuvant cisplatin-vinorelbine chemotherapy at Kyorin University Hospital between January 2006 and June 2015 were reviewed. The treatment schedule comprised cisplatin 80 mg/m on day 1 and vinorelbine 25 mg/m on days 1 and 8 every 3 weeks. Four 3-week cycles were planned. A pharmacist provided guidance to all patients and monitored them for adverse effects thereafter. The pharmacist intervened with advice to doctors as necessary. The 4 cycles were administered in 67.6% of cases. There were no treatment-related deaths. The main grade 3 or 4 toxicities were neutropenia (76.5%) and anorexia (38.2%). The most common reason for discontinuation and dose reduction was anorexia. There were 56 instances of pharmacist intervention. In total, 96.4% of the pharmacist interventions were implemented by doctors, which included administration of an antiemetic on 15 occasions and hot fomentation for prevention of vasculitis on 7 occasions. Adjuvant cisplatin-vinorelbine chemotherapy was tolerated by most patients but was discontinued because of adverse events in some. Pharmacist intervention aids completion of planned chemotherapy and management of treatment-related adverse events.
在多项III期试验中，辅助性顺铂-长春瑞滨化疗已被证明对完全切除的非小细胞肺癌（NSCLC）患者有效，但在日本人群中尚未得到证实。药剂师有望协助患者完成辅助化疗。这项回顾性研究的目的是评估日本患者辅助性顺铂-长春瑞滨化疗的依从性和安全性，并评估药剂师对治疗完成情况的贡献。回顾了2006年1月至2015年6月间在杏林大学医院接受辅助性顺铂-长春瑞滨化疗的34例NSCLC患者。治疗方案为第1天静脉滴注顺铂80mg/m²，第1天和第8天静脉滴注长春瑞滨25mg/m²，每3周重复1次，共计划进行4个3周周期。一名药剂师为所有患者提供指导，并在此后监测他们的不良反应。药剂师必要时向医生提出建议。67.6%的病例完成了4个周期的治疗。没有与治疗相关的死亡病例。主要的3级或4级毒性反应为中性粒细胞减少（76.5%）和厌食（38.2%）。停药和减量的最常见原因是厌食。药剂师共进行了56次干预。总体而言，96.4%的药剂师干预建议被医生采纳，其中包括15次给予止吐药，7次给予热敷以预防血管炎。大多数患者耐受辅助性顺铂-长春瑞滨化疗，但部分患者因不良事件而停药。药剂师的干预有助于完成计划的化疗并管理与治疗相关的不良事件。
