英菲格拉替尼的副作用如何缓解

Infigratinib is a kinase inhibitor targeting FGFR1-3 and is used to treat patients with cholangiocarcinoma with FGFR2 gene abnormalities. Although the drug has shown significant efficacy in treatment, patients may face a variety of side effects during use, such as nail toxicity, stomatitis, hyperphosphatemia, etc. Understanding how to mitigate these side effects is critical to improving patient quality of life.

Side effects of Infigratinib

Infigratinib may cause a variety of adverse reactions during treatment, involving multiple systems such as skin, eyes, metabolism, etc.

Skin and nail toxicity

Most patients will experience nail changes, including nail discoloration, thickening or loss. Dry skin and palmoplantar erythrodysesthesia syndrome are also common reactions, which may be related to the direct impact of the drug on the skin appendages.

Ocular adverse reactions

The incidence of dry eye is approximately high, and in severe cases, retinal pigment epithelial detachment (RPED) may occur. Patients often complain of blurred vision and foreign body sensation, and professional eye examinations are required for diagnosis.

Metabolic abnormalities

The incidence of hyperphosphatemia is high, and soft tissue mineralization may occur when the serum phosphorus level is >7.5 mg/dL. Abnormalities such as increased ALT/AST and hyponatremia are also common in laboratory tests.

These side effects are mostly related to the extensive inhibition of the FGFR pathway by drugs, and timely identification can help with early intervention.

How to alleviate the side effects of infigratinib

Targeted management strategies should be adopted for the side effects of different systems.

Skin and Nail Care

Keep your skin moisturized and use non-irritating skin care products. Professional manicure can be performed when the nails are diseased to avoid trauma. Patients with palmoplantar redness and swelling should wear loose shoes and socks and use urea ointment topically.

Ocular symptom management

Use artificial tears regularly, 4-6 times a day. Optical coherence tomography (OCT) should be performed immediately if vision changes occur. If RPED is diagnosed, medication should be suspended and referred to an ophthalmologist.

Treatment of metabolic abnormalities

Start a low-phosphorus diet and take oral phosphate binders when blood phosphorus is >5.5 mg/dL. >7.5mg/dL, medication needs to be suspended until serum phosphorus is ≤5.5mg/dL. Regularly monitor liver and kidney function, and adjust the dose promptly if abnormal.

These mitigation measures need to be closely coordinated with doctors and the plan should be adjusted according to individual circumstances.

Contraindications of Infigratinib

Infigratinib needs to be contraindicated or used with caution under certain circumstances.

Absolute contraindications

Absolute contraindications during pregnancy. Animal experiments show that the drug can cause fetal malformations. It is contraindicated in patients with severe hepatic impairment (Child-Pugh class C) due to lack of safety data.

Relative contraindications

Caution is required when used in combination with strong CYP3A inhibitors, which may significantly increase plasma concentrations. Patients with retinopathy should use with caution as it may aggravate eye symptoms.

Restrictions for special groups

Lactating women need to stop breastfeeding, and the safety of children has not been established. Patients with severe renal impairment require individualized evaluation.

Strictly grasping contraindications can minimize the risks of treatment, and patients should strictly follow the doctor's instructions when taking medication.