别只关心新型抗肿瘤药物,传统化疗药物也该学学了!

2022-07-12 MedSci原创 MedSci原创

化疗药物的基础知识,你都会了吗?

化疗药物是目前治疗肿瘤的主要药物,其可作用在肿瘤细胞生长繁殖的不同环节上,抑制或杀死肿瘤细胞,对原发或转移肿瘤病灶均有治疗作用。然近年来分子靶向物、免疫治疗药物等各类抗肿瘤药物层出不穷,但是传统化疗药物依旧是临床抗肿瘤治疗的主要选择

 

据化疗药物的化学结构及来源,可以将化疗药物区分为烷化剂、抗代谢类药物、植物类药物、抗生素类药物、激素类药物以及杂类药物在此,小编特别整理了化疗药物的相关知识,接下来就由小编带领大家再重新学习一下化疗药物吧!

 

一、化疗药物分类、作用机制及常见药物

 

 

二、化疗药物临床应用管理

 

  • 化疗药物使用前,应该根据产品需要,完善相关检查,如血常规、肝功能、肾功能等。

     

  • 化疗药物的配置应遵循药品说明书,选择合适溶媒以及合适稀释浓度,如羟喜树碱不宜使用葡萄糖溶液或酸性溶液溶解;吡柔比星、奥沙利铂、脂质体类药物如紫杉醇脂质体、多柔比星脂质体不宜使用生理盐水溶解。

     

  • 根据化疗药物的特性选择合适的保存环境,如顺铂、卡铂、亚叶酸钙、达卡巴嗪、长春新碱、表柔比星、放线菌素D等化疗药物应注意避光保存。

     

  • 化疗药物静脉滴注或注射时应注意滴速和给药时间。如长春瑞滨、长春地辛、米托蒽醌、阿霉素类、尼莫司汀、吉西他滨、环磷酰胺等往往需要快滴;氟尿嘧啶、亚叶酸钙、顺铂、异环磷酰胺、紫杉醇等往往需要慢滴。

     

  • 化疗药物的使用,应该遵循一定的原则进行。如化疗药物联用时,应遵循刺激性原则先使用对血管刺激小的药物,随后使用发疱剂等刺激性大的药物。化疗药物联用时,受药物相互作用影响,应当调整给药顺序,常见化疗药物联用时的给药顺序可见下表(表格内容来源于参考文献[1])。

 

 

三、化疗药物常见不良反应及处理
 
 
四、常见问题及解析
1、化疗药物耐药机制如何?应该怎么处理?
 
答:化疗药物的耐药涉及多药耐药基因、凋亡途径、非编码 RNA、肿瘤微环境等生物进程的改变。化疗后出现耐药可以考虑联合应用血管生成抑制剂、P-糖蛋白抑制剂、miRNA抑制剂、中药等抗耐药治疗药物,除此之外,新辅助化疗或免疫治疗联合化疗等方法也可能有效改善耐药。
 
2、常见化疗方案有哪些?
 
答:FP方案(顺铂+氟尿嘧啶),EP方案(依托泊苷+顺铂),TAC方案(多柔比星+紫杉醇),DCF方案(多西他赛+顺铂+氟尿嘧啶),CHOP方案(环磷酰胺+长春新碱+多柔比星+泼尼松),VCM方案(长春新碱+卡铂+甲氨蝶呤),VDLP方案(长春新碱+柔红霉素+门冬酰胺酶+泼尼松),CMF方案(环磷酰胺+甲氨蝶呤+氟尿嘧啶),IE方案(伊立替康+依托泊苷),VELOX方案(奥沙利铂+卡培他滨),FLOT方案(奥沙利铂+氟尿嘧啶+多西他赛),SOX方案(奥沙利铂+S-1),XELOX方案(奥沙利铂+卡培他滨),mFOLFOX方案(5-氟尿嘧啶+亚叶酸钙+奥沙利铂),FOLFIRI方案(伊立替康+亚叶酸钙+氟尿嘧啶),CapIRI方案(伊立替康+卡培他滨)。
参考文献:
[1] 陈静, 赵德华, 楚明明,等. 静脉用抗肿瘤药物临床应用的药学管理[J]. 肿瘤药学, 2020, 10(3):9.
[2] 药品说明书.

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