Pharmaceutical care of reactivating anthracycline chemotherapy in a patient with advanced breast cancer combined with thyroid cancer / 中国药房

ABSTRACT

OBJECTIVE To explore the pharmaceutical care of reactivating anthracycline chemotherapy in patients with advanced breast cancer complicated with thyroid cancer. METHODS Clinical pharmacists participated in the whole treatment process of a patient with advanced breast cancer complicated with thyroid cancer and provided personalized medication recommendations. Considering that the patient currently has multiple primary anti-tumor drug resistance， clinical pharmacists recommend reactivating the EC rescue protocol （intravenous infusion of epirubicin hydrochloride 140 mg+cyclophosphamide 1 g， d1， 21 days for a cycle）. The cumulative lifetime dose of epirubicin and the optimal course of chemotherapy was estimated according to the body weight change of the patient. Given the issue that abnormal fluctuation of thyroid stimulating hormone （TSH） level during chemotherapy may increase the risk of cardiac toxicity， clinical pharmacists suggest adopting a dose adjustment strategy of “fast first and slow later” for Levothyroxine sodium tablet according to the target range of TSH and test results. RESULTS The doctors adopted the pharmacists’ suggestion； the clinical pharmacists assisted the doctors in reactivating the anthracycline-based 7-cycle combination regimen， during which the patient had no significant cardiac adverse events and was repeatedly evaluated as stable. TSH decreased steadily after Levothyroxine sodium tablets were added， and no adverse reaction related to TSH inhibition was observed. CONCLUSIONS Patients with primary drug-resistant breast cancer complicated with thyroid cancer may be reactived anthracyclines if necessary， but baseline cardiac function and thyroid hormone levels should be tested before initiation， and cardiac toxicity risk assessment should be performed in combination with the patient’s history. Clinical pharmacists should actively exert their professional advantages to carry out whole-process pharmaceutical care for such patients， so as to ensure the safety of drug use for patients.