Pemetrexed於中重度腎功能不良之非小細胞肺癌治療案例報告

The Impact of Pemetrexed on the NSCLC Patient With Moderately to Severely Decreased Renal Function: A Case Report

庹聖茵(Sang-Yin To) ； 施睿琥(Jui-Hu Shih) ； 吳尚倫(Shang-Luen Wu) ； 黃志偉(Chih-Wei Huang) ； 謝政智(Cheng-Chih Hsieh)

《臺灣臨床藥學雜誌》 26卷4期 (2018/10) Pp. 310-317

https://doi.org/10.6168/FJCP.201810_26(4).0008

摘要

Pemetrexed為新一類可抑制多重標的之葉酸拮抗劑，目前為治療局部晚期或轉移性非小細胞肺癌（顯著鱗狀細胞組織型除外）之第一線化療用藥。依研究顯示，pemetrexed合併含鉑類製劑使用後（誘導治療），若繼續使用pemetrexed單一藥物作為維持治療，可延長疾病無惡化存活期與整體存活期，但卻可能增加累積性的藥物毒性反應。目前，限於少有肌酸酐清除率小於45 ml/min的病人使用pemetrexed之安全性使用分析，故藥品仿單不建議pemetrexed使用於肌酸酐清除率小於45 ml/min的病人族群。本文分享77歲晚期非小細胞肺癌病人，於維持治療期間發生肌酸酐清除率惡化至小於45 ml/min時，藉由調整pemetrexed藥物劑量與延長給藥間隔之療效與安全性使用經驗。

關鍵字

Pemetrexed ； 維持治療 ； 腎功能不良 ； 非小細胞肺癌

並列摘要

Pemetrexed is a new-generation multitargeted antifolate agent, and it's role in first-line treatment of locally advanced or metastatic non-squamous non-small-cell lung cancer (NSCLC) has been established. Maintenance therapy with pemetrexed improved progression-free survival and overall survival following a pemetrexed-containing platinum doublet induction therapy, but the risk of cumulative toxicities may be increased. Until now, there have been limited reports on the safety of pemetrexed used in patients with creatinine clearance (CrCl) level below 45 ml/ min. Therefore, according to the medication package insert, pemetrexed should not be used in patients whose CrCl level below 45 ml/min. This article will describe the effectiveness and safety of pemetrexed in a 77-year-old patient with advanced NSCLC whose CrCl level was ＜ 45 ml/min during maintenance therapy with modified dosing and scheduling.

並列關鍵字

Pemetrexed ； Maintenance Therapy ； Renal Dysfunction ； Non-Small-Cell Lung Cancer