Xu Hao, Liu Qi
Department of Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang, People's Republic of China.
Trauma Center, The First Hospital of China Medical University, Shenyang, People's Republic of China.
Onco Targets Ther. 2021 Jan 5;13:13345-13355. doi: 10.2147/OTT.S279998. eCollection 2020.
Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor, and surgical resection is the first choice for the treatment of the disease, but since the advent of tyrosine kinase inhibitors (TKIs) such as imatinib (IM), the prognosis of the disease has undergone revolutionary changes. According to the current version of the guidelines, most GIST patients receive a fixed dose without taking into account their own individual differences, resulting in a wide difference in blood concentration, adverse reactions and prognosis. With more studies on the relationship between blood drug concentrations and prognosis, the concept of individualized therapy has been paid more attention by researchers. Therapeutic drug monitoring (TDM) has also been made available for the research field of GIST targeted therapy. How to reduce the incidence of drug resistance and adverse reactions in patients with GISTs has become the focus of the current research. This article reviews the common monitoring methods and timing of TKIs blood concentration, the reasonable range of blood drug concentration, the toxic or adverse effects caused by high blood drug concentration, some possible factors affecting blood drug concentration and recent research progress, in order to discuss and summarize the treatment strategy of individual blood drug concentration, improve the prognosis of patients and reduce the adverse effects as much as possible.
胃肠道间质瘤（GIST）是最常见的间叶组织肿瘤，手术切除是该病的首选治疗方法，但自从伊马替尼（IM）等酪氨酸激酶抑制剂（TKIs）问世以来，该病的预后发生了革命性变化。根据当前版本的指南，大多数GIST患者接受固定剂量治疗，而未考虑其个体差异，导致血药浓度、不良反应和预后差异很大。随着对血药浓度与预后关系的研究增多，个体化治疗的概念受到了研究人员更多的关注。治疗药物监测（TDM）也已应用于GIST靶向治疗的研究领域。如何降低GIST患者的耐药性和不良反应发生率已成为当前研究的重点。本文综述了TKIs血药浓度的常见监测方法和时机、血药浓度的合理范围、高血药浓度引起的毒性或不良反应、一些影响血药浓度的可能因素以及近期研究进展，以探讨和总结个体血药浓度的治疗策略，改善患者预后并尽可能减少不良反应。
