优化皮里米丁治疗:DPYD基因型剂量对严重毒性率的现实影响
Anouk H E van Kan1, Ankie M Harmsze1, Karin Herbschleb2
1Department of Clinical Pharmacy, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands.
在DPYD基因型导向的甲剂量测试中,在携带变体和野生型患者中显示出类似的严重毒性率. 个人剂量定位至关重要,特别是对于C.1236G>A载体,以优化安全性.
科学领域:
- 药物基因组学
- 癌症学
- 临床药理学
背景情况:
- 国际指导方针提倡基于DPYD基因型的化物剂量.
- DPYD变种可能会影响皮里米丁的代谢和毒性.
- 在临床实践中,对DPYD基因型导向剂量的真实数据至关重要.
研究的目的:
- 评估DPYD变体携带者与野生型患者的严重甲相关毒性发生率.
- 评估目前基于DPYD基因型的国际准则的有效性.
- 在接受皮里米丁治疗的患者中确定严重毒性的预测因素.
主要方法:
- 这是一项针对初次采用皮里米丁抗癌疗法的成年患者的回顾性观察队列研究.
- 对四种主要DPYD变异进行基因定型:DPYD*2A,C.1236G>A,C.2846A>T和DPYD*13.
- 根据DPYD变种载体的国际指导方针进行剂量调整.
主要成果:
- 包括857名患者;其中71人是DPYD变体的携带者.
- 野生型的严重毒性发病率为27%,而携带者为18% (P=0. 11).
- 化学疗法组合 (氧沙利/ 多克塞尔,氧沙利/ 伊诺特干) 和放射疗法是显著的毒性预测因子.
结论:
- 在DPYD基因型导向的剂量中,野生型和变种载体之间实现了可比的毒性率.
- 目前对C.1236G>A和C.2846A>T变体的指导剂量似乎足以控制毒性.
- 建议对个体剂量进行定位,特别是对于C. 1236G> A携带者,以进一步优化患者的治疗结果.
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