臨床藥Therapeutics of Clinical Drugs 物治療 AKI 學 ph 5 AKI GFR 6 參鉑類藥物與烷化劑的腎毒性一 Cisplatin cisplatin 2 Cisplatin 1/3 cisplatin Cisplatin GFR 7,8 Cisplatin 5

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1 摘要嘉義基督教醫院藥劑科藥師蔡佩芬許育瑋壹前言 1 貳癌症患者與腎毒性之關連 (Acute kidney injury, AKI) 72-85% 2 AKI AKI AKI 3 4 (tumor lysis syndrome, TLS) AKI xanthine (glomerular filtration rate, GFR) AKI Mar 藥學雜誌臨床藥物治療學化療藥物引起的腎毒性

2 臨床藥Therapeutics of Clinical Drugs 物治療 AKI 學 ph 5 AKI GFR 6 參鉑類藥物與烷化劑的腎毒性一 Cisplatin cisplatin 2 Cisplatin 1/3 cisplatin Cisplatin GFR 7,8 Cisplatin 50 mg/m 2 8 cisplatin 3-5 cisplatin 4 cisplatin 3-4 L 4,9 Amifostine FDA glutathione cisplatin 8 (ASCO) amifostine (910 mg/m 2 ) cisplatin 10 二 Carboplatin 與 Oxaliplatin Carboplatin 8 ifosfamide 11 oxaliplatin carboplatin cisplatin 8 三 Ifosfamide Ifosfamide acrolein chloroacetaldehyde cyclophosphamide 40 cyclophosphamide 4,8 ifosfamide 2,11 Ifosfamide gm/m 2 4,6 mesna acrolein mesna 8 四 Cyclophosphamide Cyclophosphamide cyclophosphamide 66 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.1 Mar

3 24 4 五 Nitrosoureas Nitrosoureas 3-5 4,6 (renal tubular acidosis, RTA) 4 streptozotocin semustine 3/4 > 1.4 g/m 2 Carmustine lomustine 10% 6 Nitrosoureas 4 肆抗生素及抗代謝劑的腎毒性一 Mitomycin-C Mitomycin-C 4 (thrombotic thrombocytopenic purpura, TTP) (hemolytic uremic syndrome, HUS) 8 mitomycin-c % TTP HUS 60 mg HUS 4,6,11 Mitomycin-C 8 11 臨床藥物治療 4,6 mitomycin-c 20% 學 mitomycin-c 4 二 Gemcitabine Gemcitabine HUS 4 mitomycin-c 12 Gemcitabine HUS mitomycin-c BUN mitomycin-c HUS gemcitabine 11 HUS gemcitabine 12 三 Methotrexate Methotrexate (MTX) (> 1 g/ m 2 ) 7-OH-methotrexate AKI AKI MTX 2,9 MTX PH 4 (ph > 7.0) MTX 2,4,9 MTX AKI 6 probenecid salicylates sulfisoxazole 藥學雜誌 Mar

4 Therapeutics of Clinical Drugs 臨床藥物治療學 NSAID MTX imatinib 4 MTX leucovorin 11 四 Azacitidine Azacitidine 4 伍單株抗體與多重靶標酪氨酸激酶抑制劑的腎毒性一 Bevacizumab Bevacizumab (vascular endothelial growth factor, VEGF) 4 二 Cetuximab (epidermal growth factor, EGF) EGF 6 27% cetuximab 三 Imatinib tyrosine kinases imatinib imatinib AKI 9 (Fanconi syndrome) imatinib 4 imatinib 4 9 四 Dasatinib dasatinib sorafenib sunitinib vatalanib axitinib 4 陸雙磷酸鹽類的腎毒性一 Pamidronate Pamidronate ( mg) AKI 6 Pamidronate (focal glomerulosclerosis, FGS) 1 pamidronate 6 90 mg 1,14 二 Zoledronic acid Zoledronic acid 68 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.1 Mar

5 NSAID pamidronate zoledronic acid 2 14 柒結論 Toxicities Pei-Fen Tsai, Yu-Wei Hsu Department of Pharmacy, Ditmanson Medical Foundation Chia-Yi Christian Hospital Abstract Survival of cancer patients have improved by the development of chemotherapeutic agents; however, treatment with chemotherapeutic agents also increases the likelihood of renal toxicities, which may consequently complicate subsequent care. Although there are many ways to prevent renal toxicities in clinic, renal toxicities induced by chemotherapeutic agents remains an important issue in cancer patients. In addition to understanding characteristics of chemotherapeutic agents, clinicians should identify patients with high risk of renal toxicities, and provide adequate volume infusion, electrolyte repletion, and serial monitoring of renal function to decrease the risk of renal toxicities Mar 藥學雜誌臨床藥物治療學Chemotherapeutic Agents Associated Renal

6 臨床藥物治療學 Therapeutics of Clinical Drugs 參考資料 Humphreys BD, Soiffer RJ, Magee CC: Renal failure associated with cancer and its treatment: an update. J Am Soc Nephrol 2005;16(1): Finkel KW, Foringer JR: Renal disease in patients with cancer. Nat Clin Pract Nephrol 2007;3(12): Lam AQ, Humphreys BD: Onco-Nephrology: AKI in the Cancer Patient. Clin J Am Soc Nephrol 2012;7(10): Sahni V, Choudhury D, Ahmed Z: Chemotherapy associated renal dysfunction. Nat Rev Nephrol 2009;5(8): Perazella MA: Renal vulnerability to drug toxicity. Clin J Am Soc Nephrol 2009;4(7): Perazella MA, Moeckel GW: Nephrotoxicity from chemotherapeutic agents: clinical manifestations, pathobiology, and prevention/therapy. Semin Nephrol 2010;30(6): Pabla N, Dong Z: Cisplatin nephrotoxicity: Mechanisms and renoprotective strategies. Kidney Int 2008;73(9): de Jonge MJ, Verweij J: Renal toxicities of chemotherapy. Semin Oncol 2006;33(1): Buemi M, Fazio MR, Bolignano D, et al: Renal Com- 燦爛的色彩 70 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.1 Mar plications in Oncohematologic Patients. J Investig Med 2009;57(8): Hensley ML, Hagerty KL, Kewalramani T, et al: American Society of Clinical Oncology 2008 clinical practice guideline update: use of chemotherapy and radiation therapy protectants. J Clin Oncol 2009;27(1): Lameire NH, Flombaum CD, Moreau D, et al: Acute renal failure in cancer patients. Ann Med 2005;37(1): Glezerman I, Kris MG, Miller V, et al: Gemcitabine nephrotoxicity and hemolytic uremic syndrome: report of 29 cases from a single institution. Clin Nephrol 2009;71(2): Fakih MG, Wilding G, Lombardo J: Cetuximab-induced hypomagnesemia in patients with colorectal cancer. Clin Colorectal Cancer 2006;6(2): Kyle RA, Yee GC, Somerfield MR, et al: American Society of Clinical Oncology 2007 Clinical Practice Guideline Update on the Role of Bisphosphonates in Multiple Myeloma. J Clin Oncol 2007;25(17): 楊士磐郭莉萱童玟津等癌症患者使用雙磷酸鹽之風險藥學雜誌2011; 27: 23-27

臨床藥物治療學 Therapeutics of Clinical Drugs ( 5% 10%) 3 EGFRIs ( ) 4 (10-17%) TKI (5-9%) ( clindamycin 1%) doxycycline 100 mg minocycline 100 mg isot

臨床藥物治療學 Therapeutics of Clinical Drugs ( 5% 10%) 3 EGFRIs ( ) 4 (10-17%) TKI (5-9%) ( clindamycin 1%) doxycycline 100 mg minocycline 100 mg isot Therapeutics of Clinical Drugs 臨床藥物治療學表皮生長因子抑制劑皮膚併發症中山醫學大學附設醫院藥劑科藥師林政仁吳雀維中山醫學大學附設醫院醫師劉親穎摘要 (epidermal growth factor receptor inhibitors EGFRIs)

臨床藥Therapeutics of Clinical Drugs 物治療 AKI 學 ph 5 AKI GFR 6 參 鉑類藥物與烷化劑的腎毒性一 Cisplatin cisplatin 2 Cisplatin 1/3 cisplatin Cisplatin GFR 7,8 Cisplatin 5

臨床藥Therapeutics of Clinical Drugs 物治療 AKI 學 ph 5 AKI GFR 6 參鉑類藥物與烷化劑的腎毒性一 Cisplatin cisplatin 2 Cisplatin 1/3 cisplatin Cisplatin GFR 7,8 Cisplatin 5