EGFR inhibitoru toksicitāte, klīniskās izpausmes un ārstēšanas algoritms.
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Gan Latvijā, gan pasaulē ļoti bieža un izplatīta onkoloģiska slimība ir kolorektālais vēzis. Kolorektālais vēzis ir ļaundabīga slimība, kas attīstās resnās vai taisnās zarnas sieniņā. Salīdzinoši bieži šo slimību diagnosticē IV slimības stadijā, kad ir attīstījušās attālās metastāzes, biežāk aknās un plaušās.
Mūsdienās metastātiska kolorektāla vēža ārstēšanā tiek pielietota citostātiska ķīmijterapija kombinācijā ar mērķterapiju. Šobrīd aktuālās Eiropas un Amerikas vēža ārstēšanas vadlīnijas rekomendē metastātiska kolorektāla vēža ārstēšanā ķīmijterapijai pievienot epidermālo augšanas faktora receptoru inhibitorus (RAS pirmatnējā tipa) – Cetuximabum vai Panitumumabum. Vairums gadījumos šī ārstēšana ir efektīva, taču šie medikamenti var izraisīt nopietnas blakusparādības, no kurām visbiežākā un grūtāk ārstējamā ir ādas toksicitāte. Lai diagnosticētu un ārstētu EGFR inhibitoru radīto toksicitāti, un pacienti varētu sekmīgi turpināt specifisku pretvēža ārstēšanu, speciālistiem trūkst konkrētas rekomendācijas un algoritmi, kā sekmīgāk mazināt un novērst specifisko ādas toksicitāti.
Pētījuma mērķis ir uzlabot ārstiem, farmaceitiem un pacientiem zināšanas par EGFR inhibitoru ādas toksicitāti un medikamentozās ārstēšanas iespējām Latvijā.
Pētījuma uzdevumi ir:
1. Analizēt pieejamo literatūru par EGFR inhibitoru medikamentu grupām, to toksicitāti un klīniskajām izpausmēm, kā arī par ārstēšanas iespējām.
2. Izstrādāt ārstēšanas algoritmu atbilstoši EGFR inhibitoru ādas bojājumu klīniskajai izpausmei un Latvijā pieejamiem lokāli un perorāli lietojamiem medikamentiem.
Pētījumā veikts literatūras apskats, analizējot pieejamās publikācijas par EGFR inhibitoru radīto ādas toksicitāti, to atpazīšanu un novēršanas iespējām. Pētījumā tiek aplūkoti dati no Latvijas Zāļu valsts aģentūras Zāļu reģistra, lai izvērtētu Latvijā pieejamo medikamentu klāstu.
Pētījuma rezultātā ir izstrādāts EGFR inhibitoru radītās ādas toksicitātes medikamentozās ārstēšanas algoritms, atbilstoši Latvijā pieejamiem medikamentiem.
Colorectal cancer is a common and wide-spread disease in Latvia and in the whole world. Colorectal cancer is defined as malignant disease in the rectum or colon. This oncological disease is often diagnosed in stage IV, when there are metastases spread distally, commonly in the liver and the lungs. Nowadays the chemotherapy regimen consists of cytostatic agents and target therapy. Current European and American oncology guidelines recommend adding epidermal growth factor receptor inhibitors such as Cetuximabum and Panitumabum to the chemotherapy regimen in cases of RAS wild-type metastatic colorectal cancer. In most cases the therapy is successful, but these EGFR inhibitors can cause serious adverse effects, the most common and most difficult to manage is dermatological toxicity. Often conventional chemotherapy methods are not successful for patients with metastatic colorectal cancer, and there are epidermal growth factor inhibitors as a choice for therapy, although these medications can cause various toxicities, from which most serious ones are skin and nail toxicities. Specialists in Latvia often lack proper recommendations and algorithms for successful dermatological toxicity management. The aim of this study is to create algorithms for patients, physicians, and other specialists, as well as pharmacists about the clinical manifestations of EGFR inhibitor toxicities, mainly addressing skin toxicities and their possible management. The tasks of this study are: 1. to analyze available information from recent trials and studies regarding EGFR inhibitors and dermatological adverse events, identification, and prevention of dermatological toxicities. 2. to create algorithms for management of EGFR inhibitor induced dermatological toxicity based on oral and locally used medicines available in Latvia. This study analyses available information from recent trials and studies regarding EGFR inhibitors and dermatological adverse events, identification, and prevention of dermatological toxicities. This study also investigates available data from The State Agency of Medicines of Latvia about currently available medications in Latvia and based on this data forms suggestions. In result of this study algorithms for management of EGFR inhibitor induced dermatological toxicity based on orally and locally used medicines available in Latvia has been created.
Colorectal cancer is a common and wide-spread disease in Latvia and in the whole world. Colorectal cancer is defined as malignant disease in the rectum or colon. This oncological disease is often diagnosed in stage IV, when there are metastases spread distally, commonly in the liver and the lungs. Nowadays the chemotherapy regimen consists of cytostatic agents and target therapy. Current European and American oncology guidelines recommend adding epidermal growth factor receptor inhibitors such as Cetuximabum and Panitumabum to the chemotherapy regimen in cases of RAS wild-type metastatic colorectal cancer. In most cases the therapy is successful, but these EGFR inhibitors can cause serious adverse effects, the most common and most difficult to manage is dermatological toxicity. Often conventional chemotherapy methods are not successful for patients with metastatic colorectal cancer, and there are epidermal growth factor inhibitors as a choice for therapy, although these medications can cause various toxicities, from which most serious ones are skin and nail toxicities. Specialists in Latvia often lack proper recommendations and algorithms for successful dermatological toxicity management. The aim of this study is to create algorithms for patients, physicians, and other specialists, as well as pharmacists about the clinical manifestations of EGFR inhibitor toxicities, mainly addressing skin toxicities and their possible management. The tasks of this study are: 1. to analyze available information from recent trials and studies regarding EGFR inhibitors and dermatological adverse events, identification, and prevention of dermatological toxicities. 2. to create algorithms for management of EGFR inhibitor induced dermatological toxicity based on oral and locally used medicines available in Latvia. This study analyses available information from recent trials and studies regarding EGFR inhibitors and dermatological adverse events, identification, and prevention of dermatological toxicities. This study also investigates available data from The State Agency of Medicines of Latvia about currently available medications in Latvia and based on this data forms suggestions. In result of this study algorithms for management of EGFR inhibitor induced dermatological toxicity based on orally and locally used medicines available in Latvia has been created.
Description
Farmācija
Pharmacy
Veselības aprūpe
Health Care
Pharmacy
Veselības aprūpe
Health Care
Keywords
Atslēgas vārdi: EGFR inhibitori, Cetuximabum, metastātisks kolorektālais vēzis, toksicitāte, ādas reakcijas., Key words: EGFR inhibitors, Cetuximabum, metastatic colorectal cancer, toxicity, adverse skin reactions.