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关于贝伐珠单抗，你想知道的全在这里

2022-05-05 三叶草 MedSci原创

贝伐珠单抗
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贝伐珠单抗已被广泛应用于多种恶性肿瘤的治疗。

贝伐珠单抗是一种重组人源化单克隆抗体，通过特异性靶向结合人血管内皮生长因子（VEGF），抑制VEGF与其受体结合，抑制了肿瘤的血管形成，减少了肿瘤的血供、氧供和其他营养物质的供应，从而抑制肿瘤细胞生长。贝伐珠单抗于2004年获美国食品药品监督管理局批准上市，并于2010年获准进入中国市场。作为抗肿瘤血管生成的重要药物之一，贝伐珠单抗目前已经被应用于多种恶性肿瘤的治疗。

 

1、适用疾病  

 

  • 国内医保适应证：转移性结直肠癌、非小细胞肺癌、肝细胞癌和复发性胶质母细胞瘤。

     

  • 国内说明书适应证：包括四大医保适应证以及复发性卵巢上皮癌、输卵管癌或原发性腹膜癌，难治性、复发性或转移性宫颈癌。

 
除上述六大说明书适应证外，贝伐珠单抗还可应用于转移性肾癌、晚期转移性乳腺癌、放射性脑损伤以及胸腔积液、腹腔积液等适应症（国外适用）。
 
2、用法用量
3、不良反应及处理方法
 
4、毒理研究
 
5、药物相互作用
 
与舒尼替尼联用可能会发生微血管溶血性贫血的风险。
 
6、常见问题
 
（1）关于贝伐珠单抗用药期间出现高血压问题处理。
 
高血压是贝伐珠单抗用药期间最常见的不良反应，在用药期间可以参照以下管理流程处理（图1）。如果血压>160/100mmHg，应暂停贝伐珠单抗使用，建议进行药物干预，按下列管理步骤进行干预治疗（图2），每增加一种药物需至少2周后应重新测量血压进行评估。（注意：维拉帕米、地尔硫卓等CYP3A4抑制剂可能与贝伐珠单抗产生药物相互作用，影响疗效，不建议使用。）
 
图1 贝伐珠单抗治疗期间的血压(mmHg)管理流程（图源 参考文献[1]）

 

图2 初次服用降压药患者的治疗步骤（图源参考文献[1]）
 
（2）关于贝伐珠单抗是否可以用于癌症维持治疗的问题。
 
临床研究显示，贝伐珠单抗单药或联合其他化疗药物维持治疗可以有效改善晚期非小细胞肺癌、晚期卵巢癌、转移性结直肠癌、晚期乳腺癌等的PFS和OS，建议临床医生充分权衡患者的临床获益、不良反应、生活质量及经济情况，根据个体化原则及时调整治疗方案。
 
（3）关于贝伐珠单抗用药期间施行小手术的安全问题。
 
国外研究显示，在贝伐珠单抗用药期间，如果需要施行小手术（包括中央静脉置管/导管移除、胸腔引流、口腔手术、活检等），术前可能需要16-17天的停药过渡，术后如果继续贝伐珠单抗治疗，则需要9-14天的手术恢复期。
参考文献：
[1] 唐欣颖, 匡泽民. 接受贝伐珠单抗治疗的卵巢癌和宫颈癌患者血压管理专家共识》:2019英国专家建议解读. 中国合理用药探索, 2020; 1: 11-15.

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1954871, encodeId=b22419548e15b, content=<a href='/topic/show?id=e4f39220658' target=_blank style='color:#2F92EE;'>#贝伐珠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92206, encryptionId=e4f39220658, topicName=贝伐珠)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Tue Jul 26 03:29:05 CST 2022, time=2022-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1242641, encodeId=97451242641cd, content=<a href='/topic/show?id=0a9e922085f' target=_blank style='color:#2F92EE;'>#贝伐珠单抗#</a><a href='/topic/show?id=aeef922031b' target=_blank style='color:#2F92EE;'>#贝伐单抗#</a>是万能搭配，与各种<a href='/topic/show?id=6b68556562e' target=_blank style='color:#2F92EE;'>#抗肿瘤药物#</a>都可以联用, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92208, encryptionId=0a9e922085f, topicName=贝伐珠单抗), TopicDto(id=92203, encryptionId=aeef922031b, topicName=贝伐单抗), TopicDto(id=55656, encryptionId=6b68556562e, topicName=抗肿瘤药物)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=循证小兵, createdTime=Fri Sep 02 02:41:14 CST 2022, time=2022-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1218328, encodeId=e1c3121832818, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220313/1fccd8869aca4c2bbabb274c6aada833/8cdb5c5762b54b208703fcac43dcca47.jpg, createdBy=872f5678021, createdName=jing0309, createdTime=Tue May 10 03:50:32 CST 2022, time=2022-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1217671, encodeId=e4bc121e67133, content=学习了，感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e6636267722, createdName=97477_6652, createdTime=Sat May 07 17:16:16 CST 2022, time=2022-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1477122, encodeId=81f314e7122e9, content=<a href='/topic/show?id=c32e9220221' target=_blank style='color:#2F92EE;'>#贝伐#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92202, encryptionId=c32e9220221, topicName=贝伐)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ef557344179, createdName=sunrural_42825359, createdTime=Sat May 07 10:29:05 CST 2022, time=2022-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1217156, encodeId=55ac121e15654, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220313/1fccd8869aca4c2bbabb274c6aada833/8cdb5c5762b54b208703fcac43dcca47.jpg, createdBy=872f5678021, createdName=jing0309, createdTime=Thu May 05 20:41:22 CST 2022, time=2022-05-05, status=1, ipAttribution=)]
    2022-07-26 仁医06

    #贝伐珠#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1954871, encodeId=b22419548e15b, content=<a href='/topic/show?id=e4f39220658' target=_blank style='color:#2F92EE;'>#贝伐珠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92206, encryptionId=e4f39220658, topicName=贝伐珠)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Tue Jul 26 03:29:05 CST 2022, time=2022-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1242641, encodeId=97451242641cd, content=<a href='/topic/show?id=0a9e922085f' target=_blank style='color:#2F92EE;'>#贝伐珠单抗#</a><a href='/topic/show?id=aeef922031b' target=_blank style='color:#2F92EE;'>#贝伐单抗#</a>是万能搭配，与各种<a href='/topic/show?id=6b68556562e' target=_blank style='color:#2F92EE;'>#抗肿瘤药物#</a>都可以联用, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92208, encryptionId=0a9e922085f, topicName=贝伐珠单抗), TopicDto(id=92203, encryptionId=aeef922031b, topicName=贝伐单抗), TopicDto(id=55656, encryptionId=6b68556562e, topicName=抗肿瘤药物)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=循证小兵, createdTime=Fri Sep 02 02:41:14 CST 2022, time=2022-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1218328, encodeId=e1c3121832818, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220313/1fccd8869aca4c2bbabb274c6aada833/8cdb5c5762b54b208703fcac43dcca47.jpg, createdBy=872f5678021, createdName=jing0309, createdTime=Tue May 10 03:50:32 CST 2022, time=2022-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1217671, encodeId=e4bc121e67133, content=学习了，感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e6636267722, createdName=97477_6652, createdTime=Sat May 07 17:16:16 CST 2022, time=2022-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1477122, encodeId=81f314e7122e9, content=<a href='/topic/show?id=c32e9220221' target=_blank style='color:#2F92EE;'>#贝伐#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92202, encryptionId=c32e9220221, topicName=贝伐)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ef557344179, createdName=sunrural_42825359, createdTime=Sat May 07 10:29:05 CST 2022, time=2022-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1217156, encodeId=55ac121e15654, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220313/1fccd8869aca4c2bbabb274c6aada833/8cdb5c5762b54b208703fcac43dcca47.jpg, createdBy=872f5678021, createdName=jing0309, createdTime=Thu May 05 20:41:22 CST 2022, time=2022-05-05, status=1, ipAttribution=)]
    2022-09-02 循证小兵

    #贝伐珠单抗##贝伐单抗#是万能搭配，与各种#抗肿瘤药物#都可以联用

    0

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    2022-05-10 jing0309

    感谢分享

    0

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    2022-05-07 97477_6652

    学习了，感谢分享

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1954871, encodeId=b22419548e15b, content=<a href='/topic/show?id=e4f39220658' target=_blank style='color:#2F92EE;'>#贝伐珠#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92206, encryptionId=e4f39220658, topicName=贝伐珠)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=55683, createdName=仁医06, createdTime=Tue Jul 26 03:29:05 CST 2022, time=2022-07-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1242641, encodeId=97451242641cd, content=<a href='/topic/show?id=0a9e922085f' target=_blank style='color:#2F92EE;'>#贝伐珠单抗#</a><a href='/topic/show?id=aeef922031b' target=_blank style='color:#2F92EE;'>#贝伐单抗#</a>是万能搭配，与各种<a href='/topic/show?id=6b68556562e' target=_blank style='color:#2F92EE;'>#抗肿瘤药物#</a>都可以联用, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92208, encryptionId=0a9e922085f, topicName=贝伐珠单抗), TopicDto(id=92203, encryptionId=aeef922031b, topicName=贝伐单抗), TopicDto(id=55656, encryptionId=6b68556562e, topicName=抗肿瘤药物)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=循证小兵, createdTime=Fri Sep 02 02:41:14 CST 2022, time=2022-09-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1218328, encodeId=e1c3121832818, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220313/1fccd8869aca4c2bbabb274c6aada833/8cdb5c5762b54b208703fcac43dcca47.jpg, createdBy=872f5678021, createdName=jing0309, createdTime=Tue May 10 03:50:32 CST 2022, time=2022-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1217671, encodeId=e4bc121e67133, content=学习了，感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e6636267722, createdName=97477_6652, createdTime=Sat May 07 17:16:16 CST 2022, time=2022-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1477122, encodeId=81f314e7122e9, content=<a href='/topic/show?id=c32e9220221' target=_blank style='color:#2F92EE;'>#贝伐#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=92202, encryptionId=c32e9220221, topicName=贝伐)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ef557344179, createdName=sunrural_42825359, createdTime=Sat May 07 10:29:05 CST 2022, time=2022-05-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1217156, encodeId=55ac121e15654, content=感谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220313/1fccd8869aca4c2bbabb274c6aada833/8cdb5c5762b54b208703fcac43dcca47.jpg, createdBy=872f5678021, createdName=jing0309, createdTime=Thu May 05 20:41:22 CST 2022, time=2022-05-05, status=1, ipAttribution=)]
    2022-05-07 sunrural_42825359

    #贝伐#

    0

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    2022-05-05 jing0309

    感谢分享

    0

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