Division of Medical Oncology, Department of Medicine, University of Ottawa and the Ottawa Hospital, Ottawa, ON, K1H 8L6, Canada.
Department of Medicine, College of Medicine, Qassim University, Qassim, 52571, Saudi Arabia.
J Neurooncol. 2024 Sep;169(3):625-632. doi: 10.1007/s11060-024-04764-6. Epub 2024 Aug 6.
Pneumocystis jirovecii pneumonia (PJP) prophylaxis is required by provincial and national drug monographs during glioma treatment using temozolomide (TMZ) concurrently with radiation (TMZ-RT). However, real-world data suggest the potential benefits of PJP prophylaxis may not outweigh its potential harms in this population.
We conducted a single-center patient survey and a national physician survey to explore the role of PJP prophylaxis amongst glioma patients undergoing TMZ-RT.
23% (31/133) of physicians and 60% (44/73) of patients completed a survey. The median patient age was 42 (range 20-77); 85% (34/40) had completed adjuvant TMZ. Although only 2.4% (1/41) of patients received PJP prophylaxis, only one person (without PJP prophylaxis) was hospitalized for pneumonia. When presented with hypothetical PJP risks, 13.2% (5/38) of patients were concerned about PJP infection, while 26% (10/38) were concerned about potential side effects from prophylactic antibiotics. Most physicians (77%, 17/22) perceived the evidence for PJP prophylaxis as weak; 58% (11/19) did not routinely prescribe prophylaxis, and 73% (16/22) felt that PJP prophylaxis should be limited to patients with additional risk factors. Over 95% of physicians estimated that the incidence of PJP was < 1% in their last 5 years of practice regardless of PJP prophylaxis. For 73% (16/22) of physicians, to prescribe PJP prophylaxis, the risk of PJP infection needed to be 3-8%.
The current recommendation to routinely prescribe PJP prophylaxis in patients receiving TMZ-RT in the absence of other risk factors warrants reconsideration.
在使用替莫唑胺（TMZ）联合放疗治疗脑胶质瘤时，省和国家药品专论要求预防卡氏肺孢子虫肺炎（PJP）。然而，实际数据表明，在该人群中，预防 PJP 的潜在益处可能并不大于其潜在危害。
我们进行了一项单中心患者调查和一项全国医生调查，以探讨在接受 TMZ-RT 的脑胶质瘤患者中预防 PJP 的作用。
23%（31/133）的医生和 60%（44/73）的患者完成了调查。患者的中位年龄为 42 岁（范围 20-77 岁）；85%（34/40）已完成辅助 TMZ 治疗。尽管只有 2.4%（1/41）的患者接受了 PJP 预防治疗，但只有 1 人（未接受 PJP 预防治疗）因肺炎住院。当被问及假设的 PJP 风险时，13.2%（5/38）的患者担心感染 PJP，而 26%（10/38）的患者担心预防性抗生素的潜在副作用。大多数医生（77%，17/22）认为 PJP 预防治疗的证据较弱；58%（11/19）常规不开具预防治疗处方，73%（16/22）认为 PJP 预防治疗应仅限于有其他危险因素的患者。超过 95%的医生估计，无论是否使用 PJP 预防治疗，在过去 5 年的实践中，PJP 的发病率<1%。对于 73%（16/22）的医生来说，为了开具 PJP 预防治疗处方，PJP 感染的风险需要在 3-8%之间。
目前建议在没有其他危险因素的情况下，对接受 TMZ-RT 的患者常规开具 PJP 预防治疗的建议值得重新考虑。
