■在医学肿瘤学中,标准医学和补充医学之间潜在相互作用的认识和临床相关性正在增加。尽管如此,功效的研究和经验,安全,草药物质的毒性文献很少。
■这里,我们报道了1例68岁女性患者,该患者被诊断为晚期肾细胞癌并有肝和胰腺转移,并于2021年11月接受了半肝切除和胰腺转移切除手术.此后,立即开始化疗,每周3次输注pembrolizumab和每日摄入酪氨酸激酶抑制剂阿西替尼.令人惊讶的是,全身治疗开始后3个月,患者在肝脏出现早期进展和转移,然后用选择性内部放射治疗。尽管阿西替尼和派博利珠单抗继续治疗,2022年11月的短期随访发现她的胰腺有另一个转移灶.由于假定对治疗缺乏反应,测量了阿西替尼的血浆浓度,发现其显示亚治疗水平的暴露.经过长时间的回忆,患者报告定期摄入由肿瘤学针灸师处方的草药,以治疗与初次手术相关的胃肠道不适。
■进一步的临床药理检查惊人地表明,阿西替尼的治疗浓度降低了约90%,可能是由当归和白竹等草药引起的。
UNASSIGNED: The awareness and the clinical relevance of the potential interactions between standard and complementary medicine are increasing in medical oncology. Nonetheless, the research and experience of the efficacy, safety, and toxicity of herbal substances are poorly documented.
UNASSIGNED: Here, we report the
case of a 68-year-old female patient who had been diagnosed with advanced renal cell cancer with metastasis in the liver and pancreas and had undergone surgical resection with hemi-hepatectomy and resection of metastasis in the pancreas in November 2021. Thereafter, chemotherapy was immediately initiated with three-weekly infusions of pembrolizumab and daily intake of the tyrosine kinase inhibitor
axitinib. Surprisingly, 3 months after initiation of systemic treatment, the patient developed early progression and metastasis in the liver, which was then treated with selective internal radiotherapy. Despite continued
axitinib and pembrolizumab treatment, a short-term follow-up in November 2022 revealed another metastatic lesion in her pancreas. Due to the presumed lack of response to treatment, the plasma concentration of
axitinib was measured and found to demonstrate subtherapeutic levels of exposure. Upon extended anamnesis, the patient reported regular intake of herbal substances prescribed by her oncology acupuncturist for gastrointestinal complaints associated with the primary operation.
UNASSIGNED: Further clinical-pharmacological workup strikingly demonstrated a reduction of the therapeutic concentration of
axitinib of about 90%, likely caused by herbal drugs such as Dang gui and Bai zhu.