Isoniazid于膀胱癌case之处方讨论课件.ppt

1、Isoniazid於膀胱癌case之處方討論報告者:梁心怡 94-1-6Isoniazide100mg/tab 3#QD PO X 14 days Malignant neoplasm of bladderHematuria泌尿道感染泌尿道感染,未標示位置者未標示位置者12/29膀胱癌是生殖泌尿系統腫瘤中很常見的一種，其中表淺性膀胱癌約佔7成左右，在治療上如果早期發現，可以經尿道使用膀胱鏡刮除膀胱腫瘤(TUR-BT)，再使用抗癌藥物/BCG由膀胱灌注治療，可達到相當好的治療效果。ImmuCystImmuCyst (BCG(BCG免疫治療劑免疫治療劑)-是由Bacilus Calmmette-G

2、uerin(BCG)之Connaught菌株(一種牛的結核桿菌Mycobacterium bovis的活減毒菌株)所製成的凍 晶乾燥製劑.-美國FDA於1990 年核准BCG用於治療膀胱癌。臨床上臨床上BCGBCG主要是用來：主要是用來：1.膀胱原位癌(CIS)的治療。2.預防表淺性膀胱癌TUR(經尿道切除術)手術後的復發 3.殘留膀胱腫瘤的治療治療計劃治療計劃 -經膀胱投予ImmuCyst 須開始於生檢或經尿道切除術(TUR)後7-14days。包括induction therapy and maintenance therapy。induction therapy(induction th

3、erapy(誘導療程誘導療程)-qwk X 6 wks.暫停6wks,再qwk X 13wks。maintenance therapy(maintenance therapy(維持療程維持療程)-開始治療後6個月,q6mth X 13wks,直到第36個月為止。Immucyst 副副作作用用：95%無無嚴嚴重重副副作作用用 局局部部 induction maintenance BCG作作用用正正常常現現象象 短短暫暫性性無無尿尿 26%46%V 頻頻尿尿 14%34%V 血血尿尿 1119%V 嚴嚴重重GU副副作作用用 0.5 全全身身 38.5/48hr 17%31%V 嚴嚴重重副副作作用用

4、 39.5，12 hr；38.5，48hr；pneumonitis，hepatitis 易易發發生生於於：TUR或或挫挫傷傷性性導導尿尿管管(致致血血尿尿)一一週週內內即即用用BCG 正正常常現現象象：發發燒燒、血血尿尿、頻頻尿尿、急急尿尿等等，表表示示BCG已已開開始始作作用用 不不可可用用BCG：長長期期免免疫疫抑抑制制、移移植植、活活動動性性TB、AIDS、白白血血病病、Hodgkins disease 延延後後使使用用BCG：不不明明發發燒燒、嚴嚴重重膀膀胱胱/尿尿道道疼疼痛痛，UTI、挫挫傷傷(膀膀胱胱鏡鏡、導導尿尿)BCGBCG免疫治療劑相關的不良反應與治療建議免疫治療劑相關的不良

5、反應與治療建議症狀或症候群症狀或症候群治療治療(1)刺激性膀胱症狀48小時症狀治療延遲下一次ImmuCyst療程至症狀消除為止。若一週內症狀能未消除，可投與isoniazid 300mg qd直到完全緩解為止(3)伴隨UTI(細菌性尿路感染)延遲下一次ImmuCyst療程至抗微生物療程完成後，且尿液培養呈現陰性反應為止(4)其他生殖泌尿系統不良反應:症候性肉芽腫性攝護腺炎，副睪丸炎，輸尿管阻塞，或腎臟膿腫。停用ImmuCyst 投與isoniazid 300mg qd和 rifampin 600mg qd 3-6 months(5)fever38.5OC;持續hrs使用acetaminophe

6、n做症狀治療(6)皮膚發癢，關節痛，或遷移性關節炎使用antihistmines或NSAIDS若無效，停用ImmuCyst，並投與isoniazide 300mg qd 3months(7)全身性的BCG反應不具敗血性休克症候群停用ImmuCyst，尋求傳染病諮詢。投與isoniazide300mg qd，RIF 600mg qd andEMB 1000mg qd 6months(8)全身性的BCG反應具有敗血性休克症候群同(7)考慮短時間投與高劑量corticosteroids治療ISONIAZIDE THERAPEUTIC USES IN MICROMEXISONIAZID THERAPE

7、UTIC USES ACETYLATOR STATUS DETERMINATION BLADDER CANCER-PREVENTION OF TOXICITY CEREBELLAR TREMOR HUNTINGTONS DISEASE MULTIPLE SCLEROSIS MYCOBACTERIAL INFECTIONS-NON-TUBERCULOUS TUBERCULOSIS-IN HIV-INFECTED PERSONS TUBERCULOSIS-LATENT TUBERCULOSIS-PULMONARY CLINICAL APPLICATIONS THERAPEUTIC USES BLA

8、DDER CANCER-PREVENTION OF TOXICITY 1.OVERVIEW:FDA APPROVAL:Adult,no;pediatric,no EFFICACY:Adult,possibly effective DOCUMENTATION:Adult,poor 2.SUMMARY:Isoniazid maybe useful in reducing local adverse effects associated with BCG bladder instillations in patients with superficial bladder cancer.-Isonia

9、zid administered concomitantly with bladder instillations of bacillus Calmette-Guerin(BCG)significantly reduced local BCG-related adverse effects in adult patients with superficial bladder cancer.In this randomized,prospective,double-blind study,160 patients received isoniazid 300 milligrams(mg)or p

10、lacebo daily for 3 days after each of 6 consecutive weekly BCG bladder instillations(81 mg).All patients underwent transurethral tumor resection or bladder biopsies 1 to 3 weeks prior to initiating BCG treatment.-Local effects,including dysuria,hematuria,and increased micturation frequency,occurred

11、less frequently in isoniazid-treated patients(35%versus 48%,p less than 0.01).This may be a result of decreased exposure to live bacilli.-Systemic side effects,such as fever and nausea,were unaffected by the addition of isoniazid.Treatment withdrawals due to adverse effects,as well as tumor recurren

12、ces over a 2-year follow-up period,were not different between groups (Al Khalifa,2000).ISONIAZID MECHANISM OF ACTIONIN MICROMEDEX -Isoniazid is a synthetic antimycobacterial agent which is bacteriocidal for both extracellular and intracellular organisms.The drug is thought to act by interfering with

13、 cell wall mycolic acid synthesis(AMA,1986).Isoniazid is the hydrazide derivative of isonicotinic acid.While isoniazid is bacteriostatic for resting bacilli,it is bactericidal for rapidly dividing organisms.In contrast to streptomycin,another antitubercular agent,isoniazid penetrates cells easily an

14、d is equally effective against intracellular bacilli as it is against those growing in culture media(Mandell&Saude,1985).ImmuCyst(BCG免疫治療劑)所含的為活的減毒的分枝桿菌活的減毒的分枝桿菌故isoniazid可預防及治療BCG免疫治療劑經膀胱灌注所引起的不良反應。Metformin 500mg/tab 1#PO TID X 7daysAmoxacillin 500mg/cap 1#PO QID X 7daysBacillus Calmette-Guerin(BC

15、G)81mg/vail 1vial IVCT STDMMalignant neoplasm of bladder11/24Tranexamic acid 250mg/cap 2#PO TID X 3daysAlfuzosin XL 10mg/tab 1#PO HS X 3days 11/29Tranexamic acid 250mg/cap 2#PO TID X 3daysAlfuzosin XL 10mg/tab 1#PO HS X 3daysAmoxacillin 500mg/cap 1#PO TID X 3daysHematuria12/3Isoniazide100mg/tab 3#QD PO X 7 daysHematuria12/23Isoniazide100mg/tab 3#QD PO X 14 days Malignant neoplasm of bladderHematuria泌尿道感染泌尿道感染,未標示位置者未標示位置者12/29Reference1.Micromedex2.MIMS3.仿單