PRVA LINIJA FARMAKOTERAPIJE PERIFERNE NEUROPATIJE INDUKOVANE HEMIOTERAPIJOM
Sažetak
Periferna neuropatija indukovana hemioterapijom (engl. chemotherapy-induced peripheral neuropathy ‒ CIPN) predstavlja veoma čestu neželjenu pojavu, koja je jatrogeno izazvana sprovođenjem neurotoksičnih hemioterapijskih protokola na onkološkim pacijentima. Najveću neurotoksičnost među hemioterapeuticima pokazuju oksaliplatin, cisplatin, karboplatin, docetaksel, paklitaksel, vinblastin i vinkristin, boretzomib. Preporučuje se da se za prvu liniju farmakoterapije ovog neželjenog efekta hemioterapije koriste gabapentionoidi (pregabalin i gabapentin) i antidepresivi (amitrptilin, duloksetin, venlafaksin, desvenlafaksin). Takođe, preproučuje se topikalna primena lidokaina. Adekvatna farmakoterapija CIPN-a podrazumeva individualizovani pristup pacijentu i poštovanje smernica za preporučenu farmakoterapiju prve linije, najpre korišćenjem jednog leka, a potom, u zavisnosti od tolerabilnosti i postignutog analgetskog odgovora, i korišćenjem većeg broja lekova iz prve linije farmakoterapije. Treba preći na drugu liniju terapije jedino ako nema adekvatnog analgetskog odgovora na politerapiju lekovima iz prve linije. Zbrinjavanje CIPN-a omogućava bolji kvalitet života, budući da dolazi do kupiranja neuropatske komponente bola, smanjenja stepena depresivnosti i anksioznosti i predviđenog završetka planiranih hemioterapijskih ciklusa; samim tim, prognoza lečenja osnovnog onkološkog oboljenja ovih pacijenata postaje bolja.
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