背景:尽管全球普遍使用,氟嘧啶(FP;5-氟尿嘧啶和卡培他滨)相关的化疗毒性在文献中报道很少,严重毒性为10%至40%,早期毒性(暴露后60天内)为14%。反映澳大利亚癌症患者3-5级FP相关毒性发生率的数据很少,尽管毒性对患者有重大影响(住院治疗,重症监护病房(ICU)入院甚至死亡)。
目的:这项回顾性审计评估了2020年6月至2022年6月在亨特-新英格兰地方卫生区接受FP化疗的500名患者的同期队列中3-5级毒性。从公立医院记录和肿瘤学专用电子记录中提取数据,以确定毒性和相关住院率。首次暴露于含FP化疗方案后60天内发生的重症监护入院和死亡。
结果:前60天发生150例3-4级毒性事件导致87例患者住院(87/500,17.4%)。最常见的严重毒性是腹泻(39.3%),恶心和呕吐(22.7%)和发热性中性粒细胞减少症(10%)。四名病人被送进ICU,4名患者死于毒性反应.在最初的60天内,22.2%的患者需要延迟治疗,所需剂量减少21.4%,7.8%的患者因毒性而停止治疗。
结论:我们的经验反映了国际报告,可能适用于澳大利亚人口。这些数据是了解精准医学策略的潜在益处的基础,例如药物基因组筛查,以提高患者的耐受性和FP化疗处方的成本效益。
BACKGROUND: Despite common global usage,
fluoropyrimidine (FP; 5-flurouracil and capecitabine)-related chemotherapy toxicity is poorly reported in the literature, with serious toxicity ranging from 10% to 40% and early toxicity (within 60 days of exposure) quoted at 14%. Data reflecting the incidence of Grades 3-5 FP-related toxicity in Australian cancer patients is scant, despite the significant impact of toxicity on patients (hospitalisations, intensive care unit (ICU) admissions and even death).
OBJECTIVE: This retrospective audit evaluated Grades 3-5 toxicities in a contemporaneous cohort of 500 patients receiving FP chemotherapies within the Hunter-New England Local Health District from June 2020 to June 2022. Data were extracted from public hospital records and oncology-specific e-records to determine rates of toxicity and associated hospitalisations, intensive care admissions and deaths that occurred within 60 days of first exposure to FP chemotherapy-containing regimens.
RESULTS: One hundred and fifty incidents of Grades 3-4 toxicity in the first 60 days led to 87 patients presenting to hospital (87/500, 17.4%). The most common serious toxicities were diarrhoea (39.3%), nausea and vomiting (22.7%) and febrile neutropaenia (10%). Four patients were admitted to the ICU, and four patients died of toxicity. Within the first 60 days, 22.2% of patients required treatment delays, 21.4% required dose reductions, and 7.8% of patients ceased treatment because of toxicities.
CONCLUSIONS: Our experience reflects international reports and is likely generalisable to the Australian population. These data are a basis to understand the potential benefits of precision medicine strategies such as pharmacogenomic screening to improve patient tolerability and the cost-effectiveness of FP chemotherapy prescribing.