PDF(Pubmed)
Abstract：
A 76-year-old female patient presented with an iodine-refractory papillary thyroid carcinoma (PTC), diagnosed eight years earlier, with several lymph node recurrences requiring successive surgeries. Fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) imaging revealed a new unresectable loco-regional recurrence. The patient was diagnosed with a somatic BRAF V600E mutation. Therefore, dabrafenib and trametinib combination therapy was introduced and closely monitored by a dedicated multidisciplinary team, involving pharmaceutical consultations. As early as six weeks after treatment initiation, the patient reported multiple adverse events (AEs) to the clinical pharmacy team, who provided advice on resolving AEs or improving tolerance. Close interprofessional collaboration among healthcare workers involved in the care pathway allowed for the identification of the most opportune times for temporary suspension of treatment (four suspensions over seven months) or dose reduction (two reductions over 3.5 months). This resulted in a total treatment duration (one year) longer than the average times reported in the literature. The patient showed a rapid and excellent response to treatment immediately after initiation, culminating in a complete metabolic response assessed by [18F]FDG PET/CT imaging at nine months. Twenty-five months after treatment discontinuation, the disease remained controlled. Overall, dabrafenib and trametinib combination could offer excellent outcomes in selected patients with refractory BRAF-mutated PTC, with additional clinical pharmacy initiatives allowing for the optimized management of AEs and prolonged treatment periods.
摘要：
一名76岁的女性患者患有碘难治性甲状腺乳头状癌（PTC），八年前确诊,几个淋巴结复发需要连续手术。氟脱氧葡萄糖（[18F]FDG）正电子发射断层扫描/计算机断层扫描（PET/CT）成像揭示了新的不可切除的局部区域复发。患者被诊断为体细胞BRAFV600E突变。因此,dabrafenib和trametinib联合治疗由专门的多学科小组引入和密切监测，涉及药物咨询。早在治疗开始后六周，患者向临床药学团队报告了多个不良事件（AE），他们提供了解决不良事件或提高耐受性的建议。参与护理途径的医护人员之间密切的跨专业合作，可以确定临时中止治疗（七个月内四次中止）或减少剂量（3.5个月内两次减少）的最佳时机。这导致总治疗持续时间(一年)比文献中报道的平均时间长。患者在开始治疗后立即表现出快速而出色的反应，在9个月时通过[18F]FDGPET/CT成像评估达到完全代谢反应。停药25个月后，疾病仍得到控制。总的来说,dabrafenib和trametinib联合治疗可在部分难治性BRAF突变PTC患者中提供优异的结果，与其他临床药学计划允许AE的优化管理和延长治疗期。
