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癫痫与癌症:抗惊厥药与化疗药物、酪氨酸激酶抑制剂及糖皮质激素的药物相互作用

Seizures and cancer: drug interactions of anticonvulsants with chemotherapeutic agents, tyrosine kinase inhibitors and glucocorticoids.

作者信息

Bénit Christa P, Vecht Charles J

机构信息

Department of Neurology, Medical Center Haaglanden, The Hague, Netherlands (C.B.); Service Neurologie Mazarin, GH Pitié-Salpêtrière, Paris, France (C.J.V.).

出版信息

Neurooncol Pract. 2016 Dec;3(4):245-260. doi: 10.1093/nop/npv038. Epub 2015 Oct 11.

Abstract

Patients with cancer commonly experience seizures. Combined therapy with anticonvulsant drugs (AEDs) and chemotherapeutic drugs or tyrosine kinase inhibitors carries inherent risks on drug-drug interactions (DDIs). In this review, pharmacokinetic studies of AEDs with chemotherapeutic drugs, tyrosine kinase inhibitors, and glucocorticoids are discussed, including data on maximum tolerated dose, drug clearance, elimination half-life, and organ exposure. Enzyme-inducing AEDs (EIAEDs) cause about a 2-fold to 3-fold faster clearance of concurrent chemotherapeutic drugs metabolized along the same pathway, including cyclophosphamide, irinotecan, paclitaxel, and teniposide, and up to 4-fold faster clearance with the tyrosine kinase inhibitors crizotinib, dasatinib, imatinib, and lapatinib. The use of tyrosine kinase inhibitors, particularly imatinib and crizotinib, may lead to enzyme inhibition of concurrent therapy. Many of the newer generation AEDs do not induce or inhibit drug metabolism, but they can alter enzyme activity by other drugs including AEDs, chemotherapeutics and tyrosine kinase inhibitors. Glucocorticoids can both induce and undergo metabolic change. Quantitative data on changes in drug metabolism help to apply the appropriate dose regimens. Because the large individual variability in metabolic activity increases the risks for undertreatment and/or toxicity, we advocate routine plasma drug monitoring. There are insufficient data available on the effects of tyrosine kinase inhibitors on AED metabolism.

摘要

癌症患者常发生癫痫发作。抗惊厥药物(AEDs)与化疗药物或酪氨酸激酶抑制剂联合治疗存在药物相互作用(DDIs)的固有风险。在本综述中,讨论了AEDs与化疗药物、酪氨酸激酶抑制剂和糖皮质激素的药代动力学研究,包括最大耐受剂量、药物清除率、消除半衰期和器官暴露的数据。酶诱导性AEDs(EIAEDs)可使沿相同途径代谢的同时使用的化疗药物清除速度加快约2至3倍,这些化疗药物包括环磷酰胺、伊立替康、紫杉醇和替尼泊苷,而与酪氨酸激酶抑制剂克唑替尼、达沙替尼、伊马替尼和拉帕替尼合用时清除速度可加快4倍。使用酪氨酸激酶抑制剂,尤其是伊马替尼和克唑替尼,可能会导致同时进行的治疗发生酶抑制。许多新一代AEDs不会诱导或抑制药物代谢,但它们可被包括AEDs、化疗药物和酪氨酸激酶抑制剂在内的其他药物改变酶活性。糖皮质激素既能诱导代谢变化,自身也会发生代谢改变。药物代谢变化的定量数据有助于应用合适的给药方案。由于个体代谢活性差异较大,增加了治疗不足和/或毒性的风险,我们主张进行常规血浆药物监测。关于酪氨酸激酶抑制剂对AED代谢影响的数据不足。

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