Analysis of Influential Factors for Drug-induced Liver Injury Caused by Routine Lung Cancer Chemotherapy Plan and Ra- tionality Evaluation of Hepatoprotective Drugs in Our Hospital / 中国药房

OBJECTIVE： To evaluate the influential factors for drug-induced liver injury （DILI） caused by routine lung cancer chemotherapy plan and the rationality of hepatoprotective drugs. METHODS： The information of lung cancer patients receiving routine chemotherapy in our hospital from Feb. 1st， 2018 to Jan. 31st， 2019 were selected. The occurrence of DILI induced by different routine chemotherapy plans， the correlation of each influential factor with DILI and the rationality of hepatoprotective drugs were analyzed retrospectively. RESULTS： A total of 325 patients were involved in this study， among which 126 patients （38.77％） suffered from DILI， involving 109 first-level cases （33.54％） and 17 second-level cases （5.23％）. Routine chemotherapy plan included etoposide+cisplatin， gemcitabine+cisplatin， docetaxel+platinum， pemetrexed disodium+platinum. The clinical classification of DILI included hepatocyte injury type 44 cases （14.52％）， cholestasis type 38 cases （12.54％） and mixed type 37 cases （12.21％）. Totally 174 patients （53.54％） received hepatoprotective drugs during chemo-therapy， among whom 49 patients （28.16％） suffered from first-level DILI and 6 patients （3.45％） second-level DILI， with total incidence of 31.61％. Among patients without hepatoprotective drugs， 60 patients （39.74％） suffered from first-level DILI， and 11 patients （7.28％） suffered from second-level DILI， with total incidence of 47.02％. The incidence of DILI in patients without hepatoprotective drugs was significantly higher than those with hepatoprotective drugs （P＜0.05）. Among patients with hepatoprotective drugs， 23 patients （13.22％） used hepatoprotective drugs unreasonably， including 5 patients （2.87％） received 3 kinds or more hepatoprotective drugs； 3 patients （1.72％） received drugs with same mechanism repeatedly； 11 patients （6.32％） received 3 kinds or more drugs and drug with same mechanism repeatedly； 4 patients （2.30％） used drugs contrary to contraindication. Influential factor correlation analysis showed that there was a positive correlation between DILI and the dosage of chemotherapeutic drugs， treatment course and KPS before chemotherapy （P＜0.05）. CONCLUSIONS： KPS before chemotherapy， dosage of chemotherapeutic agents and treatment course are the main factors of DILI. There is still unreasonable use of drugs such as repeated use， unreasonable drug combination， violation of drug contraindications. The use of hepatoprotective drugs during chemotherapy can reduce the risk of DILI occurrence. Clinicians should be more aware of the methods and indications of hepatoprotective drugs in order to improve the effectiveness and safety of drug use.

Formulation of Chemotherapy Program and Pharmaceutical Care for a Patient with Tonsil Cancer by Clin-ical Pharmacists / 中国药房

OBJECTIVE:To explore the role of clinical pharmacists in the drug therapy for patient with tonsil cancer. METH-ODS:Clinical pharmacists participated in the drug therapy for a patient with tonsil cancer. Referring to related clinical guidelines, literatures and the characteristics of chemotherapy drug effects,combined with clinical symptoms and economic situation of pa-tient,clinical pharmacists assisted physicians to formulate chemotherapy plan of nedaplatin combined with docetaxel (Nedaplatin for injection 100 mg,d1;50 mg,d2;ivgtt,qd+Docetaxel injection 100 mg,d1,ivgtt,qd,every 3 weeks for 1 cycle)according to effectiveness and safety. Clinical pharmacists closely monitored the occurrence of ADR as depression of bone marrow,gastroin-testinal reaction and allergic reaction,and provided medication education and discharge education,such as the use of pretreated che-motherapy drugs,diet and drinking water during chemotherapy,the prevention of ADR,etc. RESULTS:Physicians adopted the suggestions of clinical pharmacists. The patient completed chemotherapy smoothly,and no ADR was found. CONCLUSIONS:In the case of there is no unified standard for chemotherapy program of tonsil cancer at present,clinical pharmacists assist physicians to formulate chemotherapy plan according to the patient's condition,the characteristics of drug effects and economical situation,as well as conduct pharmaceutical monitoring actively so as to guarantee the safety and effectiveness of chemotherapy.