毒理性
在 romidepsin 治疗皮肤 T 细胞淋巴瘤 (CTLC) 和外围 T 细胞淋巴瘤 (PTLC) 的临床试验中,治疗期间血清酶水平升高的发生率在 7% 到 20% 之间,但这些异常通常是短暂的、轻微的,并不需要调整剂量。血清 ALT 升高超过 5 倍正常上限 (ULN) 的患者占 6%。在 romidepsin 的上市前临床试验中,接受治疗的患者中没有肝炎、黄疸或临床明显的肝脏损伤的报告。Romidepsin 在临床上使用有限,但没有证据表明它与显著的肝脏损伤有关。
Romidepsin 还具有免疫调节活性,并据报道可以引起潜伏 DNA 病毒的再激活,包括Epstein-Barr 病毒、水痘带状疱疹病毒和乙型肝炎病毒。乙型肝炎再激活发生在一名最初 HBsAg 阴性但抗-HBc 和抗-HBs 反应性的患者中。尽管如此,乙型肝炎再激活的临床特征是轻微的,并且对口服抗病毒治疗有反应。在 EB 病毒相关淋巴瘤患者中,romidepsin 与 EB 病毒感染的严重再激活和急性肝炎有关,这种肝炎可能很严重,甚至可能是致命的。
可能性评分:C(可能是临床明显肝脏损伤的原因,可能是由乙型肝炎或 EB 病毒感染的再激活引起的)。
In clinical trials of romidepsin in patients with CTLC and PTLC, the rates of serum enzyme elevations during therapy ranged from 7% to 20%, but the abnormalities were usually transient and mild and did not require dose modifications. Serum ALT elevations above 5 times ULN occurred in 6% of patients. In the preregistration clinical trials of romidepsin, there were no reports of hepatitis, jaundice or clinically apparent liver injury among the treated subjects. Romidepsin has had limited clinical use, but there is no evidence that it is associated with significant liver injury.
Romidepsin also has immunomodulatory activities and has been reported to cause reactivation of latent DNA viruses including Epstein-Barr, varicella zoster and hepatitis B virus. Reactivation of hepatitis B occurred in a patient who was initially negative for HBsAg, but reactive for anti-HBc and anti-HBs. Nevertheless, the clinical features of hepatitis B reactivation were mild and responded to oral antiviral therapy. In patients with EBV associated lymphoma, romidepsin has been associated with severe reactivation of EBV infection and acute hepatitis that can be severe and even fatal.
Likelihood score: C (probable cause of clinically apparent liver injury, which can be due to reactivation of hepatitis B or EBV infection).
来源:LiverTox