Establishment and effect evaluation of a hierarchical pharmacological monitoring model for immune checkpoint inhibitors.

Abstract

159 Background: To establish a standardized pharmacy service model for PD-1 monoclonal antibodies through a case study of the practice of full pharmacy service for immune checkpoint inhibitors and to explore the effect of clinical pharmacists' participation in the full pharmacy service for PD-1 monoclonal antibodies. Methods: Patients were graded according to age, pathological stage, Carlson co-morbidity index grading and different treatment stages (preoperative neoadjuvant, postoperative adjuvant and advanced first-line, second-line and third-line or above), whether they had concomitant autoimmune diseases and combination drug use (monotherapy, combination chemotherapy, combination targeted or anti-angiogenic drugs, combination chemotherapy + targeted/anti-angiogenic drugs) to establish PD-1 The effect of this pharmacy service model was evaluated by using the immunotherapy treatment of 132 patients in Shaanxi Provincial People's Hospital who were pharmacologically monitored by clinical pharmacists. Results: 132 patients, 91 males and 41 females, 7 patients aged ≥ 70 years with stage IV tumor and Carlson co-morbidity index ≥ 9 scores were subjected to special grade pharmacological monitoring, 1 patient developed immune myocarditis, 1 patient developed immune pneumonia and reactive capillary hyperplasia, which improved after treatment with methylprednisolone, age < 70 years, stage IV tumor, Carlson Primary pharmacological monitoring was performed in 13 patients with co-morbidity index ≥9 points, of which 10 cases (76.9%) had adverse reactions, 3 cases had pulmonary infections and discontinued, 2 cases had severe thrombosis of grade 3 or higher leading to discontinuation, and the others were hyperthyroidism, hypothyroidism, hypocorticism, etc. Secondary monitoring was performed in the other 112 patients, of which 11 cases (9.8%) had adverse reactions The other cases were immune enteritis, immune encephalitis and immune myocardial injury, and most of the adverse reactions occurred in the 5th cycle after drug administration. Conclusions: By establishing a hierarchical pharmacological monitoring model; patients aged <70 years, stage IV tumors, and Carlson co-morbidity index score ≥9 are at high risk for adverse reactions to immunotherapy, and pretreatment of these patients in advance can ensure the safety of patients' medication, improve medication compliance, and improve patients' quality of life.