Todo Maki, Shirotake Suguru, Nishimoto Koshiro, Yasumizu Yota, Kaneko Gou, Kondo Hideyuki, Okabe Takashi, Makabe Hideki, Oyama Masafumi
Department of Pharmacy, International Medical Center, Saitama Medical University, Saitama, Japan
Department of Uro-Oncology, International Medical Center, Saitama Medical University, Saitama, Japan.
Anticancer Res. 2019 Feb;39(2):999-1004. doi: 10.21873/anticanres.13205.
Pazopanib is an effective treatment option for renal cell carcinoma (RCC). However, the therapy is often limited by the appearance of adverse events (AEs), including nausea/vomiting, hepatic impairment, hand-foot syndrome, diarrhea, hypertension and oral mucositis. Early management of AEs is, therefore, extremely important in order to maximize treatment outcomes.
This non-randomized controlled before-and-after study was carried out to evaluate the effectiveness of our comprehensive pharmaceutical interventions in 37 outpatients receiving pazopanib for RCC (experimental group). Data were compared with those obtained from 13 patients before the start of pharmaceutical intervention (control group).
The incidence rates of grade 2 or more nausea and anorexia were significantly lower in the experimental, than in the control group (3% versus 38% for nausea, respectively, p=0.003; 8% versus 46% for anorexia, respectively, p=0.005). Importantly, non-adherence based on patient self-assessment was not observed with intervention (0% versus 38%, p<0.001). Consequently, the median total dose of pazopanib was increased by the intervention (72,600 versus 18,200 mg, p=0.002). Moreover, the median time to treatment failure was significantly longer with intervention than before (10.2 versus 1.7 months, HR=0.23, 95% CI=0.110-0.499, p<0.001). These findings suggest that our interventions are highly effective for enhancing treatment outcomes.
帕唑帕尼是肾细胞癌（RCC）的一种有效治疗选择。然而，该疗法常因不良事件（AE）的出现而受到限制，这些不良事件包括恶心/呕吐、肝功能损害、手足综合征、腹泻、高血压和口腔黏膜炎。因此，早期管理不良事件对于最大化治疗效果极为重要。
本非随机对照前后研究旨在评估我们的综合药物干预措施对37例接受帕唑帕尼治疗肾细胞癌的门诊患者（实验组）的有效性。将数据与13例在药物干预开始前的患者（对照组）所获得的数据进行比较。
实验组中2级或更高级别的恶心和厌食的发生率显著低于对照组（恶心分别为3%对38%，p = 0.003；厌食分别为8%对46%，p = 0.005）。重要的是，干预后未观察到基于患者自我评估的不依从情况（0%对38%，p < 0.001）。因此，干预使帕唑帕尼的中位总剂量增加（72,600对18,200毫克，p = 0.002）。此外，干预后的治疗失败中位时间显著长于之前（10.2对1.7个月，HR = 0.23，95%CI = 0.110 - 0.499，p < 0.001）。这些发现表明我们的干预措施对于提高治疗效果非常有效。
