Medication options for colorectal cancer with complications

doi:10.3877/cma.j.issn.2095-3224.2018.05.004

Abstract

Abstract:

Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in China and worldwide. CRC accompany with other system diseases or insufficiency, such as kidney insufficiency, liver insufficiency, hepatitis, cardiovascular disease, agedness or weakness is not uncommon. Complications may affect the treatment choices of CRC, while CRC therapies also have an effect the complications. We overviewed the effect of complications on pharmacokinetics and pharmacodynamics of drug therapy, and discussed the optimal medication for these patients.

Key words: Colorectal neoplasms, Renal insufficiency, Liver insufficiency, Cardiac toxicity, Elderly patients

Wentong Fang, Yanhong Gu. Medication options for colorectal cancer with complications[J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2018, 07(05): 420-430.

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URL: https://zhjzcjbdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3224.2018.05.004

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References 66

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Ccr	组I		组II		组III		组IV
Ccr	>80 mL/min		51~80 mL/min		30~50 mL/min		<30 mL/min
检测时间	第1天（n=6）	第14天（n=6）	第1天（n=8）	第14天（n=7）	第1天（n=6）	第14天（n=6）	第1天（n=4）	第14天（n=2）
卡培他滨	?	?	?	?	?	?	?	?
C_max（μg/mL）	4.63	5.05	3.47	3.80	4.10	3.32	5.07	2.25/2.61
t_max（h）	1.00	1.50	2.03	1.00	2.51	2.00	1.23	2.00/0.48
AUC_0-∞（μg.h/mL）	5.95	6.46	5.40	6.13	6.73	7.23	7.06	3.88/3.98
t_1/2（h）	0.56	0.37	0.46	0.48	0.48	0.56	0.50	0.50/0.58
5′-DFCR	?	?	?	?	?	?	?	?
C_max（μg/mL）	5.20	6.26	5.15	5.38	4.65	2.71	6.23	3.37/3.95
t_max（h）	1.03	1.51	2.03	1.07	2.51	2.13	1.54	3.00/1.02
AUC_0-∞（μg.h/mL）	11.00	11.40	12.20	12.00	11.40	7.26	11.90	7.40/9.74
t_1/2（h）	0.79	0.72	0.80	0.78	0.71	0.74	0.83	0.59/0.92
5′-DFUR	?	?	?	?	?	?	?	?
C_max（μg/mL）	6.55	11.20	6.22	7.91	7.74	9.02	12.50	12.3/9.79
t_max（h）	1.03	1.51	2.05	2.00	2.98	2.63	1.54	3.00/1.02
AUC_0-∞（μg.h/mL）	13.50	18.80	13.40	15.40	18.20	23.20	23.00	22.5/22.7
t_1/2（h）	0.72	0.56	0.61	0.58	0.62	0.67	0.68	0.54/0.70
5-FU	?	?	?	?	?	?	?	?
C_max（μg/mL）	0.42	0.96	0.26	0.58	0.31	0.47	0.54	0.754/0.390
t_max（h）	1.03	1.51	2.03	1.07	2.98	2.63	1.54	3.00/1.02
AUC_0-∞（μg.h/mL）	0.80	1.53	0.55	1.09	0.72	1.18	1.01	1.456/0.966
t_1/2（h）	0.78	0.60	0.64	0.69	0.65	0.75	0.71	0.58/0.72
FBAL	?	?	?	?	?	?	?	?
C_max（μg/mL）	7.34	6.55	6.39	7.80	7.76	8.93	11.20	19.6/17.1
t_max（h）	2.57	3.00	3.00	2.00	5.01	4.02	3.50	5.00/3.12
AUC_0-∞（μg.h/mL）	37.50	36.50	35.20	44.80	69.50	63.90	133.00	163/NC
t_1/2（h）	3.07	3.88	3.38	3.25	4.42	5.45	7.29	8.85/NC

Ccr	组I		组II		组III		组IV
Ccr	>80 mL/min		51~80 mL/min		30~50 mL/min		<30 mL/min
检测时间	第1天（n=6）	第14天（n=6）	第1天（n=8）	第14天（n=7）	第1天（n=6）	第14天（n=6）	第1天（n=4）	第14天（n=2）
卡培他滨	?	?	?	?	?	?	?	?
C_max（μg/mL）	4.63	5.05	3.47	3.80	4.10	3.32	5.07	2.25/2.61
t_max（h）	1.00	1.50	2.03	1.00	2.51	2.00	1.23	2.00/0.48
AUC_0-∞（μg.h/mL）	5.95	6.46	5.40	6.13	6.73	7.23	7.06	3.88/3.98
t_1/2（h）	0.56	0.37	0.46	0.48	0.48	0.56	0.50	0.50/0.58
5′-DFCR	?	?	?	?	?	?	?	?
C_max（μg/mL）	5.20	6.26	5.15	5.38	4.65	2.71	6.23	3.37/3.95
t_max（h）	1.03	1.51	2.03	1.07	2.51	2.13	1.54	3.00/1.02
AUC_0-∞（μg.h/mL）	11.00	11.40	12.20	12.00	11.40	7.26	11.90	7.40/9.74
t_1/2（h）	0.79	0.72	0.80	0.78	0.71	0.74	0.83	0.59/0.92
5′-DFUR	?	?	?	?	?	?	?	?
C_max（μg/mL）	6.55	11.20	6.22	7.91	7.74	9.02	12.50	12.3/9.79
t_max（h）	1.03	1.51	2.05	2.00	2.98	2.63	1.54	3.00/1.02
AUC_0-∞（μg.h/mL）	13.50	18.80	13.40	15.40	18.20	23.20	23.00	22.5/22.7
t_1/2（h）	0.72	0.56	0.61	0.58	0.62	0.67	0.68	0.54/0.70
5-FU	?	?	?	?	?	?	?	?
C_max（μg/mL）	0.42	0.96	0.26	0.58	0.31	0.47	0.54	0.754/0.390
t_max（h）	1.03	1.51	2.03	1.07	2.98	2.63	1.54	3.00/1.02
AUC_0-∞（μg.h/mL）	0.80	1.53	0.55	1.09	0.72	1.18	1.01	1.456/0.966
t_1/2（h）	0.78	0.60	0.64	0.69	0.65	0.75	0.71	0.58/0.72
FBAL	?	?	?	?	?	?	?	?
C_max（μg/mL）	7.34	6.55	6.39	7.80	7.76	8.93	11.20	19.6/17.1
t_max（h）	2.57	3.00	3.00	2.00	5.01	4.02	3.50	5.00/3.12
AUC_0-∞（μg.h/mL）	37.50	36.50	35.20	44.80	69.50	63.90	133.00	163/NC
t_1/2（h）	3.07	3.88	3.38	3.25	4.42	5.45	7.29	8.85/NC

Ccr	组I	组II		组III			组IV
Ccr	≥60 mL/min	40~59 mL/min		20~39 mL/min			<20 mL/min
剂量（患者数）	130 mg/m²（n=11）	105 mg/m²（n=3）	130 mg/m²（n=6）	80 mg/m²（n=1）	105 mg/m²（n=2）	130 mg/m²（n=5）	60 mg/m²（n=1）
Cmax（μg/mL）	1.31	0.84	1.31	0.63	1.45	1.39	0.72
AUC0-∞（μg.h/mL）	16.40	32.70	39.70	29.50	42	44.60	32.20
Vss，L/m²	361	224	136	100	99	144	135
CL（L/h/m²）	4.20	1.80	1.74	1.33	1.22	1.61	0.91
0~24小时尿排泄量（%）	36.60	19.90	24.20	18.10	15.60	19	7.13

Ccr	组I	组II		组III			组IV
Ccr	≥60 mL/min	40~59 mL/min		20~39 mL/min			<20 mL/min
剂量（患者数）	130 mg/m²（n=11）	105 mg/m²（n=3）	130 mg/m²（n=6）	80 mg/m²（n=1）	105 mg/m²（n=2）	130 mg/m²（n=5）	60 mg/m²（n=1）
Cmax（μg/mL）	1.31	0.84	1.31	0.63	1.45	1.39	0.72
AUC0-∞（μg.h/mL）	16.40	32.70	39.70	29.50	42	44.60	32.20
Vss，L/m²	361	224	136	100	99	144	135
CL（L/h/m²）	4.20	1.80	1.74	1.33	1.22	1.61	0.91
0~24小时尿排泄量（%）	36.60	19.90	24.20	18.10	15.60	19	7.13

?	Katsumata等，2008^[11]	Watayo等，2010^[12]	Horimatsu等，2011^[13]	Gori S等，2014^[14]
性别	男性	男性	男性	男性
年龄（y）	65	58	50	55
治疗方案	mFOLFOX6	mFOLFOX6	mFOLFOX6	FLOX
剂量（mg/m²）	40	40~50	60~85	42.5
总剂量（mg）	68	68~85	—	85
透析开始时间	用药后30 min	用药后立即	用药后立即	用药后1.5 h
透析时间（h）	3	4	4	3.5
透析流速（mL/min）	200	200	200	220
不同剂量	1	3	3	1
游离铂C_max（μg/mL）	0.42（40）	0.27（40）	0.50（60）	0.53（42.5）
		0.22（40）	0.60（70）
		0.39（50）	0.86（85）
游离铂AUC_{0~48 h}（μg/h/mL）	Not evaluated	15.6（40）	17.6（60）	19.5（42.5）
		12.5（40）	23.6（70）
		21.5（50）	32.6（85）

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