Kou Wen, Lin Yan Yan, Su Fei, Xiang Yue, Qiao Hui, Wu Xin'An, Hou Xiao-Ming
Department of Pharmacy, The First Hospital of Lanzhou University, Lanzhou, Gansu, China.
Department of General Surgery, First Hospital of Lanzhou University, Lanzhou, Gansu, China.
Front Pharmacol. 2022 Oct 18;13:910722. doi: 10.3389/fphar.2022.910722. eCollection 2022.
Immune checkpoint inhibitors combined chemotherapy (ICIC) are widely used for various types of lung cancer in the past decade. However, ICIC related adverse events (AEs) are more serious than immune-related adverse events (irAE) or cytotoxic chemotherapy alone. This prospective interventional study aimed to evaluate the impact of the pharmaceutical care program in reducing adverse events and analyze pharmacy interventions in patients with NSCLC who receive ICIC therapies. NSCLC patients were enrolled in this study, the pharmaceutical care program was introduced after patients received the second cycle ICIC therapies, and were followed by the pharmacist for 6 months after hospital discharge. The percentages of adverse events between patients in and after the first two cycles were analyzed and compared. After the first two treatment cycles, the clinical pharmacist proposed 67 interventions in 30 patients. The most frequent types of intervention were drug discontinuation (40.3%, 27/67) followed by drug modification (14.9%, 10/67). There were significant decreases in AEs after the second cycle with respect to nausea (≥grade-2, 14% vs. 28.3%, = 0.039), constipation (≥grade-2, 8.8% vs. 21.7%, = 0.039), diarrhea (≥grade-2, 6% vs. 16.7%, = 0.031), and myelosuppression (≥grade-2, 15.8% vs. 30.0%, = 0.022). Provision of pharmaceutical care for NSCLC patients receiving ICIC therapies can optimize drug therapy and reduce adverse events.
免疫检查点抑制剂联合化疗（ICIC）在过去十年中被广泛用于治疗各类肺癌。然而，与ICIC相关的不良事件（AE）比单纯的免疫相关不良事件（irAE）或细胞毒性化疗更为严重。这项前瞻性干预研究旨在评估药学服务项目在减少不良事件方面的影响，并分析接受ICIC治疗的非小细胞肺癌（NSCLC）患者的药学干预措施。NSCLC患者被纳入本研究，在患者接受第二个周期的ICIC治疗后引入药学服务项目，并在出院后由药剂师随访6个月。分析并比较了前两个周期内及之后患者不良事件的发生率。在前两个治疗周期后，临床药剂师对30名患者提出了67项干预措施。最常见的干预类型是停药（40.3%，27/67），其次是药物调整（14.9%，10/67）。第二个周期后，恶心（≥2级，14%对28.3%，P = 0.039）、便秘（≥2级，8.8%对21.7%，P = 0.039）、腹泻（≥2级，6%对16.7%，P = 0.031）和骨髓抑制（≥2级，15.8%对30.0%，P = 0.022）等不良事件显著减少。为接受ICIC治疗的NSCLC患者提供药学服务可以优化药物治疗并减少不良事件。
