背景:Savolitinib,一种小分子抑制剂,已被批准为中国首个专门针对MET激酶的药物。显示MET外显子14跳跃的晚期非小细胞肺癌(NSCLC)患者现在有了新的创新治疗选择。
方法:在本案例报告中,我们描述了1例因服用savolitinib而出现药物性肝损伤(DILI)的患者.在使用savolitinib(每天400毫克,oral),根据1个月后进行的实验室检查,一名73岁男性患者诊断为IV期NSCLC,其MET第14外显子跳跃突变,肝酶和胆红素水平升高.经过14天的保肝药物治疗,肝功能恢复到正常状态.接受savolitinib(每天200mg,口服)一周,患者再次被诊断为严重肝功能损害。然后停用savolitinib并接受保肝药物治疗一周。肝功能恢复正常后,另一种尝试是给予少量的savolitinib(每天100毫克,oral).到目前为止,该患者已接受随访,未出现肝损伤复发。此外,肺部CT扫描显示肿瘤正在缩小,没有明显的扩散或转移迹象。RousselUclaf因果关系评估方法(RUCAM)确定savolitinib是DILI的“极可能”原因。中度-重度被确定为DILI严重程度。
结论:据我们了解,这是在现实环境中使用savolitinib作为独立治疗导致的DILI的最初实例.在使用savolitinib期间,医疗保健专业人员应仔细考虑DILI的潜在发生。给患者服用少量的savolitinib会导致对肿瘤的显着反应,导致我们推测,savolitinib的有效性可能与其血浆浓度有关。研究savolitinib的药代动力学和药效学(PK/PD)有利于定制和准确地为每个人开出药物处方。
BACKGROUND: Savolitinib, a small molecule inhibitor, has gained approval as the inaugural medication in China that specifically targets MET kinase. Patients with advanced non-small cell lung cancer (NSCLC) who show MET exon 14 skipping now have a new and innovative treatment option available.
METHODS: In this case report, we describe a patient who experienced drug-induced liver injury (DILI) due to the administration of savolitinib. After being prescribed with
savolitinib (400 mg per day, oral), a 73-year-old male diagnosed with stage IV NSCLC with MET exon 14 skipping mutation experienced an increase in liver enzymes and bilirubin levels according to his laboratory tests conducted one month later. Following a 14-day course of hepatoprotective medication, the liver function reverted back to its normal state. After receiving
savolitinib (200 mg per day, oral) for one week, the patient was once again diagnosed with severe liver impairment. Then
savolitinib was discontinued and received treatment with hepatoprotective drugs for one week. Following the restoration of normal liver function, another attempt was made to administer a small amount of savolitinib (100 mg per day, oral). Thus far, the patient has been followed up and there has been no recurrence of liver damage. Additionally, the lung CT scan revealed ongoing tumor shrinkage with no apparent indications of spreading or metastasis. The Roussel Uclaf Causality Assessment Method (RUCAM) determined that savolitinib was \"highly probable\" cause of DILI. Moderate-severe was determined to be the extent of DILI severity.
CONCLUSIONS: To the best of our understanding, this is the initial instance of DILI resulting from the use of savolitinib as a standalone treatment in a real-world setting. During the administration of savolitinib, healthcare professionals should carefully consider the potential occurrence of DILI. Administering the patient with a small amount of savolitinib resulted in a remarkable response against the tumor, leading us to speculate that the effectiveness of savolitinib might be associated with its plasma concentration. Studying the pharmacokinetics and pharmacodynamics (PK/PD) of
savolitinib is beneficial for tailoring and accurately prescribing the medication to each individual.