甲磺酸阿帕替尼引发手足综合征五例临床分析

发布时间：2018-05-11 00:11

本文选题：手足综合征 + 抗肿瘤药　；参考：《中国全科医学》2017年18期

【摘要】：目的分析5例甲磺酸阿帕替尼引发手足综合征(HFS)的临床特征,为临床医生提供相关的诊治帮助。方法收集2015—2016年丽水市人民医院皮肤科诊治的5例甲磺酸阿帕替尼引发的HFS患者的临床资料。回顾性分析5例患者的一般资料、临床表现、治疗建议及随访结果。结果 5例患者中男2例,女3例;原发肿瘤:胃癌4例,乳腺癌1例;甲磺酸阿帕替尼使用剂量750~850 mg/d;潜伏期16~35 d;常见不良反应事件评价标准(CTCAE)分级为1~3级。3例甲磺酸阿帕替尼引发的HFS CTCAE分级为1级的患者临床表现为手掌和足底散在红斑,无自觉症状;1例CTCAE分级为2级的患者临床表现为上述部位水肿性红斑伴有麻木和轻微疼痛感;1例CTCAE分级为3级的患者临床表现为上述部位水肿红斑基础上伴有脱屑、水疱,以及难以忍受的刺痛感。5例HFS患者均给予疾病相关健康教育,减少手足部受刺激,建议补充B族维生素,根据患者的自觉症状酌情使用塞来昔布止痛,同时配合外用润肤剂保湿护肤。CTCAE分级为1~2级的4例患者经治疗后HFS均得到很好的控制,未影响继续使用甲磺酸阿帕替尼的肿瘤治疗;对于1例CTCAE分级为3级的患者,在上述治疗无效且HFS持续加重时,把甲磺酸阿帕替尼服用剂量减少为500 mg/d后HFS症状明显缓解。结论新近应用于临床的抗肿瘤药物甲磺酸阿帕替尼引发的HFS并不少见,通过对症治疗或者减少使用剂量一般可以控制HFS的病情,不影响其继续应用于肿瘤的治疗。
[Abstract]:Objective to analyze the clinical features of 5 cases of HFSinduced by apatinib mesylate, and to provide help for clinicians. Methods the clinical data of 5 patients with HFS caused by Apatinib mesylate were collected from the dermatology department of the people's Hospital of Lishui City from 2015 to 2016. The general data, clinical manifestations, treatment suggestions and follow-up results of 5 patients were analyzed retrospectively. Results among the 5 patients, there were 2 males and 3 females, including 4 cases of gastric cancer and 1 case of breast cancer. The dose of Apatinib mesylate was 750 ~ 850 mg / d; the incubation period was 1635 days; the criteria for the evaluation of common adverse reaction events (CTCAE) was 1 ~ 3 grade 3. 3 patients with HFS CTCAE grade 1 caused by Apatinib mesylate had clinical manifestations of erythema on the palms and the soles of the feet. The clinical manifestations of 1 case with CTCAE grade 2 were edema erythema with numbness and slight pain. One patient with grade 3 of CTCAE grade had demectic erythema and blisters on the basis of erythema edema. All patients with HFS were given disease-related health education to reduce the stimulation of their hands and feet. It was suggested that B vitamins should be added and celecoxib should be used to relieve pain according to the patients' conscious symptoms. At the same time, the HFS of 4 patients with external moisturizing, skin care and skin care. CTCAE grade 1 and 2 were all well controlled after treatment and did not affect the treatment of cancer with Apatinib mesylate. For one patient with CTCAE grade 3, When the above treatment was ineffective and HFS continued to worsen, the symptoms of HFS were significantly alleviated after the dosage of apatinib mesylate was reduced to 500 mg/d. Conclusion HFS induced by Apatinib mesylate is not uncommon. The disease of HFS can be controlled by symptomatic treatment or reduced dosage without affecting its continued application in tumor therapy.
【作者单位】：浙江省丽水市人民医院皮肤病与性病科;浙江省丽水市人民医院乳腺疾病诊治中心/甲状腺乳腺外科;
【基金】：浙江省医药卫生科技计划项目(2012KYA193)
【分类号】：R758.2

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