使用干血微量样本对酪氨酸激酶抑制剂进行治疗药物监测

Therapeutic Drug Monitoring of Tyrosine Kinase Inhibitors Using Dried Blood Microsamples.

作者信息

Verougstraete Nick, Stove Veronique, Verstraete Alain G, Stove Christophe P

机构信息

Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.

Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium.

出版信息

Front Oncol. 2022 Mar 22;12:821807. doi: 10.3389/fonc.2022.821807. eCollection 2022.

Abstract

Therapeutic drug monitoring (TDM) of tyrosine kinase inhibitors (TKIs) is not yet performed routinely in the standard care of oncology patients, although it offers a high potential to improve treatment outcome and minimize toxicity. TKIs are perfect candidates for TDM as they show a relatively small therapeutic window, a wide inter-patient variability in pharmacokinetics and a correlation between drug concentration and effect. Moreover, most of the available TKIs are susceptible to various drug-drug interactions and medication adherence can be checked by performing TDM. Plasma, obtained traditional venous blood sampling, is the standard matrix for TDM of TKIs. However, the use of plasma poses some challenges related to sampling and stability. The use of dried blood microsamples can overcome these limitations. Collection of samples finger-prick is minimally invasive and considered convenient and simple, enabling sampling by the patients themselves in their home-setting. The collection of small sample volumes is especially relevant for use in pediatric populations or in pharmacokinetic studies. Additionally, working with dried matrices improves compound stability, resulting in convenient and cost-effective transport and storage of the samples. In this review we focus on the different dried blood microsample-based methods that were used for the quantification of TKIs. Despite the many advantages associated with dried blood microsampling, quantitative analyses are also associated with some specific difficulties. Different methodological aspects of microsampling-based methods are discussed and applied to TDM of TKIs. We focus on sample preparation, analytics, internal standards, dilution of samples, external quality controls, dried blood spot specific validation parameters, stability and blood-to-plasma conversion methods. The various impacts of deviating hematocrit values on quantitative results are discussed in a separate section as this is a key issue and undoubtedly the most widely discussed issue in the analysis of dried blood microsamples. Lastly, the applicability and feasibility of performing TDM using microsamples in a real-life home-sampling context is discussed.

摘要

酪氨酸激酶抑制剂(TKIs)的治疗药物监测(TDM)在肿瘤患者的标准治疗中尚未常规开展,尽管它具有改善治疗效果和将毒性降至最低的巨大潜力。TKIs是TDM的理想候选药物,因为它们的治疗窗相对较窄,患者间药代动力学差异较大,且药物浓度与疗效之间存在相关性。此外,大多数现有的TKIs易受各种药物相互作用的影响,通过进行TDM可以检查药物依从性。通过传统静脉采血获得的血浆是TKIs TDM的标准基质。然而,血浆的使用在采样和稳定性方面存在一些挑战。使用干血微量样本可以克服这些限制。通过手指针刺采集样本微创,被认为方便简单,使患者能够在自己家中自行采样。采集少量样本对于儿科人群或药代动力学研究尤为重要。此外,使用干燥基质可提高化合物稳定性,从而便于样本的运输和储存,且成本效益高。在本综述中,我们重点关注用于定量TKIs的不同基于干血微量样本的方法。尽管干血微量采样有许多优点,但定量分析也存在一些特定困难。本文讨论了基于微量采样方法的不同方法学方面,并将其应用于TKIs的TDM。我们重点关注样本制备、分析、内标、样本稀释、外部质量控制、干血斑特定验证参数、稳定性和血-浆转换方法。在单独的一节中讨论了血细胞比容值偏差对定量结果的各种影响,因为这是一个关键问题,无疑也是干血微量样本分析中讨论最广泛的问题。最后,讨论了在实际家庭采样环境中使用微量样本进行TDM的适用性和可行性。

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