酪氨酸激酶抑制剂相关不良反应的管理:改善肝细胞癌患者的预后。

Management of adverse events associated with tyrosine kinase inhibitors: Improving outcomes for patients with hepatocellular carcinoma.

机构信息

Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy.

Clinical Pharmacology and Pharmacogenetics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, Pisa, Italy.

出版信息

Cancer Treat Rev. 2019 Jul;77:20-28. doi: 10.1016/j.ctrv.2019.05.004. Epub 2019 May 15.

Abstract

Hepatocellular carcinoma (HCC) is the most common form of primary liver cancer. Sorafenib, regorafenib, lenvatinib and cabozantinib are tyrosine kinase inhibitors (TKIs) that target, in part, vascular endothelial growth factor receptors, and are approved in various regions of the world for the treatment of advanced HCC. All these agents are associated with a range of adverse events (AEs) that can have a substantial impact on patients' health-related quality of life. Fatigue, diarrhoea, hand-foot skin reaction, nausea, vomiting, decreased appetite, hypertension and weight loss are among the most common AEs experienced with these four TKIs. In this review, we discuss strategies for the management of these AEs in patients with advanced HCC, with the aim of maximizing treatment benefits and minimizing the need for TKI treatment discontinuation. We also consider potential TKI-drug interactions and discuss the use of TKIs in patients with liver dysfunction or who have experienced tumour recurrence after liver transplantation. Use of appropriate AE management strategies and avoidance of contraindicated drugs should help patients with advanced HCC to achieve optimal outcomes with TKIs.

摘要

肝细胞癌 (HCC) 是原发性肝癌最常见的形式。索拉非尼、regorafenib、仑伐替尼和卡博替尼是部分针对血管内皮生长因子受体的酪氨酸激酶抑制剂 (TKI),已在世界多个地区获得批准用于治疗晚期 HCC。所有这些药物都与一系列不良反应 (AE) 相关,这些不良反应可能对患者的健康相关生活质量产生重大影响。疲劳、腹泻、手足皮肤反应、恶心、呕吐、食欲下降、高血压和体重减轻是这四种 TKI 最常见的不良反应。在这篇综述中,我们讨论了管理晚期 HCC 患者这些不良反应的策略,旨在最大限度地提高治疗效果并尽量减少 TKI 治疗中断的需要。我们还考虑了潜在的 TKI-药物相互作用,并讨论了肝功能障碍或肝移植后复发患者使用 TKI 的问题。使用适当的 AE 管理策略和避免禁忌药物应有助于晚期 HCC 患者从 TKI 治疗中获得最佳效果。

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