药师在胃肠间质瘤多学科诊疗团队中的作用

doi:10.5246/jcps.2021.07.048

中国药学(英文版) ›› 2021, Vol. 30 ›› Issue (7): 598-605.DOI: 10.5246/jcps.2021.07.048

药师在胃肠间质瘤多学科诊疗团队中的作用

周毅¹^,^*(), 吴星烨², 李娟¹, 程伟³, 李小松³, 沈依帆³, 张军²^,^*()

1. 重庆医科大学附属第一医院药学部, 重庆 400016
2. 重庆医科大学附属第一医院胃肠外科, 重庆 400016
3. 重庆医科大学附属第一医院临床分子医学检测中心, 重庆 400016

收稿日期:2021-04-10 修回日期:2021-05-20 接受日期:2021-06-14 出版日期:2021-07-27 发布日期:2021-07-27
通讯作者: 周毅, 张军
作者简介:
+ Tel.: +86-23-89012410, E-mail: johnny@hospital.cqmu.edu.cn
+ E-mail: zjun2323@sina.cn
基金资助:
Chongqing Science and Technology Bureau and Chongqing Health Commission (Grant No. 2021-MSXM335 and 2020GDRC009).

Clinical and economic benefits of a pharmacist in a multidisciplinary team for Chinese outpatients with gastrointestinal stromal tumors

Yi Zhou¹^,^*(), Xingye Wu², Juan Li¹, Wei Cheng³, Xiaosong Li³, Yifan Shen³, Jun Zhang²^,^*()

1 Department of Pharmacy, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
2 Department of Gastrointestinal Surgery, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
3 The Center for Clinical Molecular Medical Detection, the First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China

Received:2021-04-10 Revised:2021-05-20 Accepted:2021-06-14 Online:2021-07-27 Published:2021-07-27
Contact: Yi Zhou, Jun Zhang

摘要/Abstract

摘要：

多学科诊疗手段有利于胃肠道间质瘤的治疗。然而, 药师很少被纳入胃肠间质瘤的多学科诊疗团队中。本回顾性研究旨在评估药师在胃肠道间质瘤多学科诊疗团队中的临床和经济价值。药师建立了高效液相色谱法向胃肠道间质瘤患者提供血药浓度监测服务; 此外, 药师也前往胃肠道间质瘤门诊进行患者教育和提供药学服务, 并收集数据进行分析。240名胃肠间质瘤患者接受了药师提供的服务, 有25.42%的患者的谷浓度小于1100 ng/mL。121名患者完成了肿瘤分子诊断检测, 主要基因型为KIT 11外显子突变、野生型和KIT 9外显子突变。13名谷浓度小于1100 ng/mL的胃肠道间质瘤患者被证实依从性较低并得到纠正。13名胃肠道间质瘤患者因不耐受不良反应而降低剂量, 通过监测血药浓度和降低剂量, 每日服药成本也能够降低。

关键词: 药师, 伊马替尼, 多学科诊疗团队, 胃肠道间质瘤, 谷浓度

Abstract:

The multidisciplinary approach is beneficial to the treatment of gastrointestinal stromal tumors (GISTs). However, pharmacists are seldom incorporated into a multidisciplinary team (MDT) of GIST. In the present study, we evaluated the clinical and economic benefits of a pharmacist in an MDT of GIST. This was a retrospective study that included 240 GIST patients receiving imatinib therapy. The GIST MDT pharmacist developed and validated an HPLC method to monitor the trough concentrations of imatinib in GIST patients. Besides, the pharmacist also provided patient education and pharmaceutical care services and collected the data for analysis. The 240 GIST patients received the services provided by the pharmacist. The trough concentrations in 25.42% of the 240 patients were less than 1100 ng/mL. The main genotypes of 121 in the 240 patients were KIT exon 11 mutations, wild type, and KIT exon 9 mutations. Moreover, 13 GIST patients with trough concentrations less than 1100 ng/mL were confirmed to have low compliance. The adverse reactions were primarily mild and tolerable, except that 13 GIST patients were adjusted to lower doses because of the intolerable adverse reactions. The daily cost could be lowered by monitoring the trough concentrations and dose reductions. Collectively, a pharmacist included in a GIST MDT could increase the compliance of Chinese GIST patients to imatinib therapy and improve the efficacy, safety, and economy of imatinib therapy.

Key words: Pharmacist, Imatinib, Multidisciplinary team, Gastrointestinal stromal tumor, Trough concentration

Supporting:

周毅, 吴星烨, 李娟, 程伟, 李小松, 沈依帆, 张军. 药师在胃肠间质瘤多学科诊疗团队中的作用[J]. 中国药学(英文版), 2021, 30(7): 598-605.

Yi Zhou, Xingye Wu, Juan Li, Wei Cheng, Xiaosong Li, Yifan Shen, Jun Zhang. Clinical and economic benefits of a pharmacist in a multidisciplinary team for Chinese outpatients with gastrointestinal stromal tumors[J]. Journal of Chinese Pharmaceutical Sciences, 2021, 30(7): 598-605.

图/表 5

Table 1. The demographic information of GIST patients.

Figure 1. The trough concentrations of imatinib in different doses (A, n = 240) and GIST patients with different genotypes (B, n = 121). Each symbol represents a single GIST patient.

Figure 2. The difference of the trough concentrations in GIST patients with low compliance (n = 13). Frist, the concentrations of the first determination. Second, the concentrations of the second determination. Each symbol represents a single GIST patient.

Figure 3. The adverse reactions occurring in the GIST patients taking imatinib (A, n = 361) and the trough concentrations of the patients with dose reduction adjustments (B, n = 13). Each symbol represents a single GIST patient. The percentage was calculated as (the number of each adverse reaction/the total number (n = 361)) *100.

Figure 4. The trough concentrations of imatinib in GIST patients taking more than two drugs simultaneously (n = 47). Each symbol represents a single GIST patient.

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药师在胃肠间质瘤多学科诊疗团队中的作用

Clinical and economic benefits of a pharmacist in a multidisciplinary team for Chinese outpatients with gastrointestinal stromal tumors

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