课件：结肠癌内科治疗基本策略潘宏铭.ppt

4. Management Toxicities 器官功能 肝功能 在转移性大肠癌患者中，肝功能不全与多发转移有关 基础肝脏疾病(如病毒性或药物性) 肝转移性肿瘤 会显著影响经肝代谢药物的浓度 伊立替康不能用于胆红素 2 mg/dL的患者 器官功能 肾功能 肾负责代谢大部分抗肿瘤药物 奥沙利铂不用于肌酐清除率 20 mL/min的患者 肌酐清除率下降的患者服用卡培他滨后毒性增加 肌酐清除率在30-50 mL/min的患者，按25%量给药 肌酐清除率30 mL/min的患者禁忌给药 伴随疾病 患者的伴随疾病会显著影响其转移性大肠癌一线治疗方案的选择 例如 在有基础性糖尿病性外周神经病变的患者中使用奥沙利铂应谨慎 在有基础性肠道疾病或接受过盆腔手术/放疗的患者中使用伊利替康应谨慎 有基础性心脏疾病的患者对5-FU引起的心脏毒性更加敏感 关于高血压的考虑 贝伐单抗: 抗VEGF 单克隆抗体 发生3/4度高血压的比率升高 (10% to 15%) 不能用于伴有未控制或严重高血压的转移性大肠癌患者 会增加中风和/或其他动脉栓塞事件的风险 尤其是65周岁及以上的患者 THANK YOU SUCCESS * * 可编辑 Moertel et al. Ann Intern Med. 1995;122:321. Francini et al. Gastroenterol. 1994;106:899. Wolmark et al. Proc Am Soc Clin Oncol. 1996;15:205. Abstract O’Connell et al. J Clin Oncol. 1998;16:295. Haller et al. Proc Am Soc Clin Oncol. 1998;17:256a. Abstract 982. Andre et al. Proc Am Soc Clin Oncol. 2002. Abstract 529. 所有70 岁或者 II 期患者均应考虑进行错配修复蛋白（ MMR）检测。具有 MSI-H（高度微卫星不稳定）的Ⅱ期患者可能预后较好， 且不会从 5-FU 的辅助化疗中获益。 * 转移性大肠癌, metastatic 大肠癌. ? Many drugs are metabolized by the liver, and liver function is a critical element in deciding which drug to use in 患者s with 大肠癌. Poor liver function may be a result of multiple causes in 患者s with metastatic 大肠癌. Liver dysfunction could be a result of the metastatic disease directly involving the liver, but it also could be due to preexisting liver disease, such as viral hepatitis or drug-induced hepatitis and/or cirrhosis. Liver dysfunction can significantly alter the clinical pharmacology and pharmacokinetics of drugs metabolized by the liver. The best example is the topoisomerase-1 inhibitor, irinotecan, which should be used with caution in 患者s with elevated serum bilirubin levels (ie, 2?mg/dL). * 大肠癌l, creatinine clearance. ? The kidneys play a key role in the clearance of a wide range of anticancer drugs, including both oxaliplatin and the oral 5-FU agent capecitabine, which are used in the treatment of 大肠癌. Data have suggested that oxaliplatin can be given safely in 患者s with creatinine clearances as low as 20?mL/min. Ho