Fujii Hironori
Department of Pharmacy, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan.
J Pharm Health Care Sci. 2024 Dec 18;10(1):81. doi: 10.1186/s40780-024-00403-4.
Adverse events (AEs) induced by cancer chemotherapy reduce not only patient quality of life (QOL) but also the efficacy of treatment. Management of AEs can therefore improve both the efficacy and safety of cancer chemotherapy. This review describes the contribution of pharmacists to the management of adverse events aimed at improving the treatment efficacy of cancer chemotherapy. Efforts to improve the evidence-practice gap are a useful approach to countermeasures against AEs. Pharmacists can intervene in these efforts in the course of their daily practice. Here, we made undertook to improve the evidence-practice gap in prophylaxis pharmacotherapy for chemotherapy-induced nausea and vomiting (CINV) and anti-EGFR antibody-induced acneiform rash. After intervention by pharmacists, the rate of adherence to prophylaxis pharmacotherapy for these AEs was significantly improved, and the incidence of CINV and acneiform rash was significantly decreased. Notably, time to treatment failure (TTF) with anti-EGFR antibody therapy tended to be increased, and may have contributed to an improvement in therapeutic effect. Next, we examined adverse events associated with anti-cancer drugs related to the therapeutic effect of cancer chemotherapy. Incidence of hypomagnesemia in patients receiving anti-EGFR antibodies and neutropenia in patients receiving TAS-102 was significantly associated with the therapeutic effect of cancer chemotherapy. Moreover, we examined the impact of cancer cachexia, a cancer-associated AE, on the therapeutic effect of immune checkpoint inhibitors. In patients receiving nivolumab, the presence of cancer cachexia prior to treatment initiation was associated with shorter OS and TTF. In summary, pharmacist management of AEs was shown to improve treatment response. Further, AEs which are predictive of treatment response in cancer chemotherapy were identified. Management of these AEs is an important role for pharmacists aiming to improve patient QOL and treatment efficacy.
癌症化疗引起的不良事件（AE）不仅会降低患者的生活质量（QOL），还会影响治疗效果。因此，对不良事件的管理可以提高癌症化疗的疗效和安全性。本综述描述了药剂师在不良事件管理中所做的贡献，旨在提高癌症化疗的治疗效果。缩小证据与实践之间的差距是应对不良事件的有效方法。药剂师可以在日常工作中参与这些工作。在此，我们致力于缩小化疗引起的恶心和呕吐（CINV）以及抗表皮生长因子受体（EGFR）抗体引起的痤疮样皮疹预防性药物治疗的证据与实践之间的差距。经过药剂师的干预，这些不良事件预防性药物治疗的依从率显著提高，CINV和痤疮样皮疹的发生率显著降低。值得注意的是，抗EGFR抗体治疗的治疗失败时间（TTF）有延长趋势，这可能有助于提高治疗效果。接下来，我们研究了与癌症化疗治疗效果相关的抗癌药物引起的不良事件。接受抗EGFR抗体治疗的患者中低镁血症的发生率以及接受TAS - 102治疗的患者中中性粒细胞减少的发生率与癌症化疗的治疗效果显著相关。此外，我们研究了癌症恶病质（一种与癌症相关的不良事件）对免疫检查点抑制剂治疗效果的影响。在接受纳武单抗治疗的患者中，治疗开始前存在癌症恶病质与较短的总生存期（OS）和TTF相关。总之，药剂师对不良事件的管理被证明可以改善治疗反应。此外，还确定了在癌症化疗中可预测治疗反应的不良事件。对这些不良事件的管理是药剂师旨在提高患者生活质量和治疗效果的重要职责。
