{"id":37455,"date":"2021-10-20T22:20:48","date_gmt":"2021-10-20T15:20:48","guid":{"rendered":"https:\/\/pharmog.com\/wp\/?p=37455"},"modified":"2025-01-07T22:45:42","modified_gmt":"2025-01-07T15:45:42","slug":"trastuzumab-herticad","status":"publish","type":"post","link":"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/","title":{"rendered":"Trastuzumab &#8211; Herticad"},"content":{"rendered":"<p><em>Thu\u1ed1c Herticad l\u00e0 thu\u1ed1c g\u00ec ? D\u01b0\u1edbi \u0111\u00e2y l\u00e0 n\u1ed9i dung t\u1edd h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng g\u1ed1c c\u1ee7a Thu\u1ed1c Herticad (Th\u00f4ng tin bao g\u1ed3m li\u1ec1u d\u00f9ng, c\u00e1ch d\u00f9ng, ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, th\u1eadn tr\u1ecdng, d\u01b0\u1ee3c l\u00fd&#8230;)<\/em><\/p><div id=\"ez-toc-container\" class=\"ez-toc-v2_0_81 ez-toc-wrap-left counter-hierarchy ez-toc-counter ez-toc-white ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">N\u1ed9i dung ch\u00ednh<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 eztoc-toggle-hide-by-default' ><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#1-ten-hoat-chat-va-biet-duoc\" >1. T\u00ean ho\u1ea1t ch\u1ea5t v\u00e0 bi\u1ec7t d\u01b0\u1ee3c:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#2-dang-bao-che-%e2%80%93-ham-luong\" >2. D\u1ea1ng b\u00e0o ch\u1ebf &#8211; H\u00e0m l\u01b0\u1ee3ng:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#3-video-by-pharmog\" >3. Video by Pharmog:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#4-ung-dung-lam-sang\" >4. \u1ee8ng d\u1ee5ng l\u00e2m s\u00e0ng:<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#41-chi-dinh\" >4.1. Ch\u1ec9 \u0111\u1ecbnh:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#42-lieu-dung-%e2%80%93-cach-dung\" >4.2. Li\u1ec1u d\u00f9ng &#8211; C\u00e1ch d\u00f9ng:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#43-chong-chi-dinh\" >4.3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#44-than-trong\" >4.4 Th\u1eadn tr\u1ecdng:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#45-su-dung-cho-phu-nu-co-thai-va-cho-con-bu\" >4.5 S\u1eed d\u1ee5ng cho ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#46-tac-dung-khong-mong-muon-adr\" >4.6 T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n (ADR):<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#47-huong-dan-cach-xu-tri-adr\" >4.7 H\u01b0\u1edbng d\u1eabn c\u00e1ch x\u1eed tr\u00ed ADR:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#48-tuong-tac-voi-cac-thuoc-khac\" >4.8 T\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#49-qua-lieu-va-xu-tri\" >4.9 Qu\u00e1 li\u1ec1u v\u00e0 x\u1eed tr\u00ed:<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-14\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#5-co-che-tac-dung-cua-thuoc\" >5. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c :<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-15\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#51-duoc-luc-hoc\" >5.1. D\u01b0\u1ee3c l\u1ef1c h\u1ecdc:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-16\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#52-duoc-dong-hoc\" >5.2. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-17\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#53-giai-thich\" >5.3 Gi\u1ea3i th\u00edch:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-18\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#54-thay-the-thuoc\" >5.4 Thay th\u1ebf thu\u1ed1c :<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-19\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#6-phan-thong-tin-kem-theo-cua-thuoc\" >6. Ph\u1ea7n th\u00f4ng tin k\u00e8m theo c\u1ee7a thu\u1ed1c:<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-20\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#61-danh-muc-ta-duoc\" >6.1. Danh m\u1ee5c t\u00e1 d\u01b0\u1ee3c:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-21\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#62-tuong-ky\" >6.2. T\u01b0\u01a1ng k\u1ef5 :<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-22\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#63-bao-quan\" >6.3. B\u1ea3o qu\u1ea3n:<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-23\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#64-thong-tin-khac\" >6.4. Th\u00f4ng tin kh\u00e1c :<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-24\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#65-tai-lieu-tham-khao\" >6.5 T\u00e0i li\u1ec7u tham kh\u1ea3o:<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-25\" href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herticad\/#7-nguoi-dang-tai-tac-gia\" >7. Ng\u01b0\u1eddi \u0111\u0103ng t\u1ea3i \/T\u00e1c gi\u1ea3:<\/a><\/li><\/ul><\/nav><\/div>\n\n<h1><span class=\"ez-toc-section\" id=\"1-ten-hoat-chat-va-biet-duoc\"><\/span>1. T\u00ean ho\u1ea1t ch\u1ea5t v\u00e0 bi\u1ec7t d\u01b0\u1ee3c:<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p><strong><em>Ho\u1ea1t ch\u1ea5t :<\/em> <\/strong><a href=\"https:\/\/pharmog.com\/wp\/trastuzumab\/\"><strong>Trastuzumab<\/strong><\/a><\/p>\n<p><strong><em>Ph\u00e2n lo\u1ea1i: <\/em><\/strong><em>Thu\u1ed1c ch\u1ed1ng ung th\u01b0.<\/em><\/p>\n<p><strong><em>Nh\u00f3m<\/em><\/strong> <strong><em>ph\u00e1p l\u00fd: <\/em><\/strong><em>Thu\u1ed1c k\u00ea \u0111\u01a1n ETC \u2013 (Ethical drugs, prescription drugs, Prescription only medicine)<\/em><\/p>\n<p><strong><em>M\u00e3 ATC<\/em><\/strong> (Anatomical Therapeutic Chemical): L01XC03.<\/p>\n<p><strong><em>Bi\u1ec7t d\u01b0\u1ee3c g\u1ed1c:<\/em><\/strong> <a href=\"https:\/\/pharmog.com\/wp\/trastuzumab-herceptin\/\"><strong>Herceptin<\/strong><\/a><\/p>\n<p><strong><em>Bi\u1ec7t d\u01b0\u1ee3c:<\/em><\/strong> Herticad<\/p>\n<p><strong><em>H\u00e3ng s\u1ea3n xu\u1ea5t <\/em><\/strong>: JSC &#8220;BIOCAD&#8221;<\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<h1><span class=\"ez-toc-section\" id=\"2-dang-bao-che-%e2%80%93-ham-luong\"><\/span>2. D\u1ea1ng b\u00e0o ch\u1ebf &#8211; H\u00e0m l\u01b0\u1ee3ng:<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p><strong><em>D\u1ea1ng thu\u1ed1c v\u00e0 h\u00e0m l\u01b0\u1ee3ng<\/em><\/strong><\/p>\n<p>B\u1ed9t \u0111\u00f4ng kh\u00f4 pha truy\u1ec1n t\u0129nh m\u1ea1ch: 150 mg; 440 mg.<\/p>\n<p>H\u1ed9p 1 l\u1ecd b\u1ed9t \u0111\u00f4ng kh\u00f4 pha dung d\u1ecbch truy\u1ec1n t\u0129nh m\u1ea1ch. L\u1ecd trastuzumab ch\u1ee9a b\u1ed9t pha dung d\u1ecbch ti\u00eam truy\u1ec1n m\u00e0u tr\u1eafng \u0111\u1ebfn v\u00e0ng nh\u1ea1t.<\/p>\n<p><strong><em>Thu\u1ed1c tham kh\u1ea3o:<\/em><\/strong><\/p>\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\"><strong><em>HERTICAD 150mg<\/em><\/strong><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><em>M\u1ed7i l\u1ecd b\u1ed9t pha dung d\u1ecbch ti\u00eam truy\u1ec1n t\u0129nh m\u1ea1ch c\u00f3 ch\u1ee9a:<\/em><\/td>\n<\/tr>\n<tr>\n<td>Trastuzumab<\/td>\n<td>&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<\/td>\n<td>150 mg<\/td>\n<\/tr>\n<tr>\n<td>T\u00e1 d\u01b0\u1ee3c<\/td>\n<td>&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<\/td>\n<td>v\u1eeba \u0111\u1ee7 (Xem m\u1ee5c 6.1)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><img loading=\"lazy\" decoding=\"async\" width=\"413\" height=\"462\" class=\"wp-image-37456\" src=\"https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2021\/10\/word-image-240.png\" srcset=\"https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2021\/10\/word-image-240.png 413w, https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2021\/10\/word-image-240-268x300.png 268w\" sizes=\"auto, (max-width: 413px) 100vw, 413px\" \/><\/p>\n<table>\n<tbody>\n<tr>\n<td colspan=\"2\"><strong><em>HERTICAD 440mg<\/em><\/strong><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td colspan=\"3\"><em>M\u1ed7i l\u1ecd b\u1ed9t pha dung d\u1ecbch ti\u00eam truy\u1ec1n t\u0129nh m\u1ea1ch c\u00f3 ch\u1ee9a:<\/em><\/td>\n<\/tr>\n<tr>\n<td>Trastuzumab<\/td>\n<td>&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<\/td>\n<td>440 mg<\/td>\n<\/tr>\n<tr>\n<td>T\u00e1 d\u01b0\u1ee3c<\/td>\n<td>&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;&#8230;.<\/td>\n<td>v\u1eeba \u0111\u1ee7 (Xem m\u1ee5c 6.1)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><img loading=\"lazy\" decoding=\"async\" width=\"488\" height=\"490\" class=\"wp-image-37457\" src=\"https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2021\/10\/word-image-241.png\" srcset=\"https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2021\/10\/word-image-241.png 488w, https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2021\/10\/word-image-241-300x300.png 300w, https:\/\/pharmog.com\/wp\/wp-content\/uploads\/2021\/10\/word-image-241-150x150.png 150w\" sizes=\"auto, (max-width: 488px) 100vw, 488px\" \/><\/p>\n<h1><span class=\"ez-toc-section\" id=\"3-video-by-pharmog\"><\/span>3. Video by Pharmog:<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p><strong>[VIDEO D\u01af\u1ee2C L\u00dd]<\/strong><\/p>\n<p>&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;<\/p>\n<p>\u25ba K\u1ecbch B\u1ea3n: PharmogTeam<\/p>\n<p>\u25ba Youtube: https:\/\/www.youtube.com\/c\/pharmog<\/p>\n<p>\u25ba Facebook: https:\/\/www.facebook.com\/pharmog\/<\/p>\n<p>\u25ba Group : H\u1ed9i nh\u1eefng ng\u01b0\u1eddi m\u00ea d\u01b0\u1ee3c l\u00fd<\/p>\n<p>\u25ba Instagram : https:\/\/www.instagram.com\/pharmogvn\/<\/p>\n<p>\u25ba Website: pharmog.com<\/p>\n<h1><span class=\"ez-toc-section\" id=\"4-ung-dung-lam-sang\"><\/span>4. \u1ee8ng d\u1ee5ng l\u00e2m s\u00e0ng:<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<h2><span class=\"ez-toc-section\" id=\"41-chi-dinh\"><\/span>4.1. Ch\u1ec9 \u0111\u1ecbnh:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><em>Ung th\u01b0 v\u00fa di c\u0103n (MBC)<\/em><\/p>\n<p>Trastuzumab \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa di c\u0103n c\u00f3 kh\u1ed1i u b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c HER2:<\/p>\n<p>a) d\u01b0\u1edbi d\u1ea1ng \u0111\u01a1n tr\u1ecb cho nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng m\u1ed9t hay nhi\u1ec1u ph\u00e1c \u0111\u1ed3 h\u00f3a tr\u1ecb cho b\u1ec7nh ung th\u01b0 di c\u0103n c\u1ee7a h\u1ecd.<\/p>\n<p>b) k\u1ebft h\u1ee3p v\u1edbi paclitaxel ho\u1eb7c docetaxel \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nh\u1eefng b\u1ec7nh nh\u00e2n ch\u01b0a \u0111\u01b0\u1ee3c d\u00f9ng h\u00f3a tr\u1ecb cho b\u1ec7nh ung th\u01b0 di c\u0103n c\u1ee7a h\u1ecd.<\/p>\n<p>c) k\u1ebft h\u1ee3p v\u1edbi thu\u1ed1c \u1ee9c ch\u1ebf aromatase \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb nh\u1eefng b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa di c\u0103n c\u00f3 th\u1ee5 th\u1ec3 hormone d\u01b0\u01a1ng t\u00ednh.<\/p>\n<p><em>Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm (EBC)<\/em><\/p>\n<p>Trastuzumab \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm c\u00f3 HER2 d\u01b0\u01a1ng t\u00ednh sau ph\u1eabu thu\u1eadt, h\u00f3a tr\u1ecb (h\u1ed7 tr\u1ee3 tr\u01b0\u1edbc ph\u1eabu thu\u1eadt ho\u1eb7c sau ph\u1eabu thu\u1eadt) v\u00e0 x\u1ea1 tr\u1ecb (n\u1ebfu c\u00f3).<\/p>\n<p><em>Ung th\u01b0 d\u1ea1 d\u00e0y di c\u0103n<\/em><\/p>\n<p>Trastuzumab k\u1ebft h\u1ee3p v\u1edbi capecitabine ho\u1eb7c 5-fluorouracil truy\u1ec1n t\u0129nh m\u1ea1ch v\u00e0 cisplatin \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u1ec7nh nh\u00e2n ung th\u01b0 d\u1ea1 d\u00e0y ho\u1eb7c ung th\u01b0 mi\u1ec7ng n\u1ed1i d\u1ea1 d\u00e0y-th\u1ef1c qu\u1ea3n di c\u0103n c\u00f3 HER2 d\u01b0\u01a1ng t\u00ednh m\u00e0 tr\u01b0\u1edbc \u0111\u00f3 ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng ung th\u01b0 cho b\u1ec7nh ung th\u01b0 di c\u0103n c\u1ee7a h\u1ecd.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"42-lieu-dung-%e2%80%93-cach-dung\"><\/span>4.2. Li\u1ec1u d\u00f9ng &#8211; C\u00e1ch d\u00f9ng:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><strong><em>C\u00e1ch d\u00f9ng<\/em><\/strong> :<\/p>\n<p>N\u00ean d\u00f9ng li\u1ec1u t\u1ea5n c\u00f4ng c\u1ee7a trastuzumab truy\u1ec1n t\u0129nh m\u1ea1ch trong 90 ph\u00fat. Kh\u00f4ng ti\u00eam bolus t\u0129nh m\u1ea1ch hay ti\u00eam nhanh. Truy\u1ec1n t\u0129nh m\u1ea1ch ch\u1ec9 \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n b\u1edfi nh\u00e2n vi\u00ean y t\u1ebf v\u00e0 ph\u1ea3i c\u00f3 s\u1eb5n b\u1ed9 kit kh\u1ea9n c\u1ea5p trong tr\u01b0\u1eddng h\u1ee3p s\u1ed1c ph\u1ea3n v\u1ec7. N\u00ean theo d\u00f5i b\u1ec7nh nh\u00e2n \u00edt nh\u1ea5t 6 gi\u1edd sau khi b\u1eaft \u0111\u1ea7u ti\u00eam truy\u1ec1n l\u1ea7n \u0111\u1ea7u ti\u00ean v\u00e0 hai gi\u1edd sau khi ti\u00eam truy\u1ec1n l\u1ea7n ti\u1ebfp theo cho c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 s\u1ed1t, \u1edbn l\u1ea1nh hay c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c li\u00ean quan \u0111\u1ebfn ti\u00eam truy\u1ec1n, truy\u1ec1n gi\u00e1n \u0111o\u1ea1n hay truy\u1ec1n ch\u1eadm c\u00f3 th\u1ec3 gi\u00fap ki\u1ec3m so\u00e1t nh\u1eefng tri\u1ec7u ch\u1ee9ng n\u00e0y. C\u00f3 th\u1ec3 ti\u1ebfp t\u1ee5c truy\u1ec1n n\u1ebfu tri\u1ec7u ch\u1ee9ng gi\u1ea3m. N\u1ebfu li\u1ec1u t\u1ea5n c\u00f4ng \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t, c\u00f3 th\u1ec3 ch\u1ec9 \u0111\u1ecbnh truy\u1ec1n li\u1ec1u ti\u1ebfp theo trong 30 ph\u00fat.<\/p>\n<p><em>C\u00e1c h\u01b0\u1edbng d\u1eabn \u0111\u1eb7c bi\u1ec7t v\u1ec1 s\u1eed d\u1ee5ng, thao t\u00e1c v\u00e0 th\u1ea3i b\u1ecf<\/em><\/p>\n<p>N\u00ean s\u1eed d\u1ee5ng k\u1ef9 thu\u1eadt v\u00f4 tr\u00f9ng th\u00edch h\u1ee3p.<\/p>\n<p>L\u1ecd trastuzumab 150 mg \u0111\u01b0\u1ee3c pha v\u1edbi 7,2 ml n\u01b0\u1edbc v\u00f4 tr\u00f9ng \u0111\u1ec3 ti\u00eam.<\/p>\n<p>N\u00ean thao t\u00e1c c\u1ea9n th\u1eadn trong khi pha Trastuzumab. T\u1ea1o nhi\u1ec1u b\u1ecdt trong khi pha ho\u1eb7c l\u1eafc dung d\u1ecbch Trastuzumab sau khi pha c\u00f3 th\u1ec3 g\u00e2y kh\u00f3 kh\u0103n cho vi\u1ec7c r\u00fat \u0111\u00fang l\u01b0\u1ee3ng Trastuzumab ra kh\u1ecfi l\u1ecd.<\/p>\n<p><em>H\u01b0\u1edbng d\u1eabn pha lo\u00e3ng<\/em><\/p>\n<p>X\u00e1c \u0111\u1ecbnh th\u1ec3 t\u00edch dung d\u1ecbch c\u1ea7n truy\u1ec1n d\u1ef1a tr\u00ean<\/p>\n<p>&#8211; li\u1ec1u t\u1ea3i 4mg trastuzumab\/kg tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3, hay li\u1ec1u duy tr\u00ec 2mg trastuzumab\/kg tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3:<\/p>\n<p>Th\u1ec3 t\u00edch (ml) = [Tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 (kg) x li\u1ec1u (4mg\/kg v\u1edbi li\u1ec1u t\u1ea3i ho\u1eb7c 2mg\/kg v\u1edbi li\u1ec1u duy tr\u00ec)]\/21(mg\/ml, n\u1ed3ng \u0111\u1ed9 dung d\u1ecbch sau khi pha)<\/p>\n<p>&#8211; li\u1ec1u t\u1ea3i 8mg trastuzumab\/kg tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3, hay li\u1ec1u duy tr\u00ec 6mg trastuzumab\/kg tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 m\u1ed7i ba tu\u1ea7n:<\/p>\n<p>Th\u1ec3 t\u00edch (ml) = [Tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 (kg) x li\u1ec1u (8mg\/ kg v\u1edbi li\u1ec1u t\u1ea3i ho\u1eb7c 6mg\/kg v\u1edbi li\u1ec1u duy tr\u00ec)]\/21 (mg\/ml, n\u1ed3ng \u0111\u1ed9 dung d\u1ecbch sau khi pha)<\/p>\n<p>L\u01b0\u1ee3ng thu\u1ed1c pha th\u00edch h\u1ee3p n\u00ean \u0111\u01b0\u1ee3c r\u00fat ra kh\u1ecfi l\u1ecd thu\u1ed1c v\u00e0 cho v\u00e0o t\u00fai d\u1ecbch truy\u1ec1n c\u00f3 ch\u1ee9a 250ml chloride natri 0,9%. Kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng dung d\u1ecbch Dextrose (5%). Nh\u1eb9 nh\u00e0ng d\u1ed1c ng\u01b0\u1ee3c t\u00fai d\u1ecbch truy\u1ec1n \u0111\u1ec3 h\u00f2a tan dung d\u1ecbch m\u00e0 kh\u00f4ng t\u1ea1o b\u1ecdt. Ph\u1ea3i quan s\u00e1t b\u1eb1ng m\u1eaft c\u00e1c s\u1ea3n ph\u1ea9m thu\u1ed1c ti\u00eam truy\u1ec1n \u0111\u1ec3 ph\u00e1t hi\u1ec7n c\u00e1c m\u1ea3nh c\u1eb7n v\u00e0 hi\u1ec7n t\u01b0\u1ee3ng \u0111\u1ed5i m\u00e0u tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng. N\u00ean s\u1eed d\u1ee5ng ngay sau khi \u0111\u00e3 chu\u1ea9n b\u1ecb xong d\u1ecbch truy\u1ec1n (xem ph\u1ea7n B\u1ea3o qu\u1ea3n).<\/p>\n<p><strong><em>Li\u1ec1u d\u00f9ng:<\/em><\/strong><\/p>\n<p><em>L\u1ecbch truy\u1ec1n h\u00e0ng tu\u1ea7n:<\/em><\/p>\n<p><em>Li\u1ec1u t\u1ea3i:<\/em> Li\u1ec1u t\u1ea3i kh\u1edfi \u0111\u1ea7u \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 4 mg\/kg tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 truy\u1ec1n t\u0129nh m\u1ea1ch trong 90 ph\u00fat. B\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i nh\u1eefng tri\u1ec7u ch\u1ee9ng nh\u01b0 s\u1ed1t v\u00e0 \u1edbn l\u1ea1nh hay nh\u1eefng tri\u1ec7u ch\u1ee9ng do ti\u00eam truy\u1ec1n kh\u00e1c. Ng\u1eebng truy\u1ec1n c\u00f3 th\u1ec3 ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c nh\u1eefng tri\u1ec7u ch\u1ee9ng n\u00e0y. Vi\u1ec7c truy\u1ec1n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c l\u1ea1i khi c\u00e1c tri\u1ec7u ch\u1ee9ng \u0111\u00e3 gi\u1ea3m b\u1edbt.<\/p>\n<p><em>Li\u1ec1u k\u1ebf ti\u1ebfp:<\/em> Li\u1ec1u khuy\u1ebfn c\u00e1o m\u1ed7i tu\u1ea7n c\u1ee7a Trastuzumab l\u00e0 2mg\/kg tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3. N\u1ebfu li\u1ec1u d\u00f9ng tr\u01b0\u1edbc \u0111\u00f3 \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t, c\u00f3 th\u1ec3 truy\u1ec1n trong 30 ph\u00fat. B\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c theo d\u00f5i c\u00e1c tri\u1ec7u ch\u1ee9ng nh\u01b0 s\u1ed1t v\u00e0 r\u00e9t run ho\u1eb7c c\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c li\u00ean quan \u0111\u1ebfn vi\u1ec7c ti\u00eam truy\u1ec1n.<\/p>\n<p>Trong c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng, b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi Trastuzumab cho \u0111\u1ebfn khi b\u1ec7nh ti\u1ebfn tri\u1ec3n.<\/p>\n<p><em>L\u1ecbch truy\u1ec1n m\u1ed7i 3 tu\u1ea7n<\/em><\/p>\n<p>Li\u1ec1u t\u1ea3i kh\u1edfi \u0111\u1ea7u l\u00e0 8mg\/kg tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3, 3 tu\u1ea7n sau l\u00e0 6mg\/kg tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 v\u00e0 sau \u0111\u00f3 l\u1eb7p l\u1ea1i li\u1ec1u 6mg\/kg tr\u1ecdng l\u01b0\u1ee3ng c\u01a1 th\u1ec3 m\u1ed7i 3 tu\u1ea7n, truy\u1ec1n t\u0129nh m\u1ea1ch trong kho\u1ea3ng 90 ph\u00fat. N\u1ebfu li\u1ec1u tr\u01b0\u1edbc \u0111\u00f3 \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t, c\u00f3 th\u1ec3 truy\u1ec1n t\u0129nh m\u1ea1ch m\u1ed9t li\u1ec1u trong kho\u1ea3ng 30 ph\u00fat.<\/p>\n<p>N\u1ebfu b\u1ec7nh nh\u00e2n qu\u00ean li\u1ec1u c\u1ee7a trastuzumab kho\u1ea3ng 1 tu\u1ea7n ho\u1eb7c \u00edt h\u01a1n, n\u00ean d\u00f9ng li\u1ec1u th\u01b0\u1eddng l\u1ec7 c\u1ee7a trastuzumab (6mg\/kg) c\u00e0ng s\u1edbm c\u00e0ng t\u1ed1t (kh\u00f4ng n\u00ean ch\u1edd cho \u0111\u1ebfn li\u1ec1u k\u1ebf ti\u1ebfp nh\u01b0 \u0111\u00e3 \u0111\u1ecbnh). Li\u1ec1u trastuzumab duy tr\u00ec k\u1ebf ti\u1ebfp l\u00e0 6mg\/kg n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng sau m\u1ed7i 3 tu\u1ea7n, theo nh\u01b0 l\u1ecbch truy\u1ec1n tr\u01b0\u1edbc \u0111\u00e2y.<\/p>\n<p>N\u1ebfu b\u1ec7nh nh\u00e2n qu\u00ean li\u1ec1u c\u1ee7a trastuzumab nhi\u1ec1u h\u01a1n m\u1ed9t tu\u1ea7n, n\u00ean l\u1eb7p l\u1ea1i li\u1ec1u t\u1ea3i (8mg\/kg trong kho\u1ea3ng 90 ph\u00fat). Li\u1ec1u trastuzumab duy tr\u00ec k\u1ebf ti\u1ebfp l\u00e0 6mg\/kg n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng sau \u0111\u00f3 m\u1ed7i 3 tu\u1ea7n t\u00ednh t\u1eeb th\u1eddi \u0111i\u1ec3m \u0111\u00f3.<\/p>\n<p>Trong c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng, b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa di c\u0103n ho\u1eb7c ung th\u01b0 d\u1ea1 d\u00e0y di c\u0103n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Trastuzumab cho \u0111\u1ebfn khi b\u1ec7nh ti\u1ebfn tri\u1ec3n. B\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm c\u1ea7n \u0111i\u1ec1u tr\u1ecb trong 1 n\u0103m ho\u1eb7c cho \u0111\u1ebfn khi b\u1ec7nh t\u00e1i ph\u00e1t.<\/p>\n<p><em>Gi\u1ea3m li\u1ec1u<\/em><\/p>\n<p>Li\u1ec1u Trastuzumab kh\u00f4ng \u0111\u01b0\u1ee3c gi\u1ea3m trong c\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb trong th\u1eddi k\u1ef3 \u1ee9c ch\u1ebf t\u1ee7y x\u01b0\u01a1ng do h\u00f3a tr\u1ecb li\u1ec7u c\u00f3 th\u1ec3 ph\u1ee5c h\u1ed3i, nh\u01b0ng c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c theo d\u00f5i c\u1ea9n th\u1eadn bi\u1ebfn ch\u1ee9ng gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh trong th\u1eddi gian n\u00e0y. Tham kh\u1ea3o t\u00f3m t\u1eaft \u0111\u1eb7c t\u00ednh s\u1ea3n ph\u1ea9m c\u1ee7a paclitaxel, docetaxel ho\u1eb7c thu\u1ed1c \u1ee9c ch\u1ebf atomatase \u0111\u1ec3 bi\u1ebft th\u00eam th\u00f4ng tin gi\u1ea3m li\u1ec1u ho\u1eb7c gi\u1eef nguy\u00ean li\u1ec1u.<\/p>\n<p><em>Qu\u00ean li\u1ec1u<\/em><\/p>\n<p>N\u1ebfu b\u1ec7nh nh\u00e2n qu\u00ean 1 li\u1ec1u kho\u1ea3ng 1 tu\u1ea7n ho\u1eb7c \u00edt h\u01a1n, n\u00ean d\u00f9ng li\u1ec1u duy tr\u00ec th\u00f4ng th\u01b0\u1eddng (ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb h\u00e0ng tu\u1ea7n: 2 mg\/kg, ph\u00e1c \u0111\u1ed3 m\u1ed7i 3 tu\u1ea7n: 6 mg\/kg) ngay khi c\u00f3 th\u1ec3. Kh\u00f4ng ch\u1edd \u0111\u1ebfn chu k\u1ef3 k\u1ebf ti\u1ebfp theo. Li\u1ec1u duy tr\u00ec sau \u0111\u00f3 ph\u00e1c \u0111\u1ed3 h\u00e0ng tu\u1ea7n: 2 mg\/kg; ph\u00e1c \u0111\u1ed3 m\u1ed7i 3 tu\u1ea7n: 6 mg\/kg) n\u00ean \u0111\u01b0\u1ee3c d\u00f9ng trong 7 ng\u00e0y ho\u1eb7c 21 ng\u00e0y sau \u0111\u00f3 theo l\u1ecbch tr\u00ecnh h\u00e0ng tu\u1ea7n ho\u1eb7c m\u1ed7i ba tu\u1ea7n t\u01b0\u01a1ng \u1ee9ng.<\/p>\n<p>N\u1ebfu b\u1ec7nh nh\u00e2n qu\u00ean 1 li\u1ec1u trastuzumab h\u01a1n 1 tu\u1ea7n, n\u00ean truy\u1ec1n l\u1ea1i li\u1ec1u t\u1ea5n c\u00f4ng c\u1ee7a trastuzumab trong kho\u1ea3ng 90 ph\u00fat (ph\u00e1c \u0111\u1ed3 h\u00e0ng tu\u1ea7n: 4 mg\/kg, ph\u00e1c \u0111\u1ed3 m\u1ed7i 3 tu\u1ea7n: 8 mg\/kg). Li\u1ec1u duy tr\u00ec sau \u0111\u00f3 (ph\u00e1c \u0111\u1ed3 h\u00e0ng tu\u1ea7n: 2 mg\/kg; ph\u00e1c \u0111\u1ed3 m\u1ed7i 3 tu\u1ea7n: 6 mg\/kg) sau \u0111\u00f3 th\u1ef1c hi\u1ec7n theo li\u1ec7u tr\u00ecnh (ph\u00e1c \u0111\u1ed3 h\u00e0ng tu\u1ea7n: m\u1ed7i tu\u1ea7n; ph\u00e1c \u0111\u1ed3 m\u1ed7i 3 tu\u1ea7n: m\u1ed7i 3 tu\u1ea7n)<\/p>\n<p><em>C\u00e1c h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng li\u1ec1u v\u1edbi \u0111\u1ed1i t\u01b0\u1ee3ng b\u1ec7nh nh\u00e2n \u0111\u1eb7c bi\u1ec7t <\/em><\/p>\n<p><em>Ng\u01b0\u1eddi gi\u00e0<\/em><\/p>\n<p>C\u00e1c d\u1eef li\u1ec7u cho th\u1ea5y \u0111\u1eb7c t\u00ednh d\u01b0\u1ee3c \u0111\u1ed9ng c\u1ee7a Trastuzumab kh\u00f4ng b\u1ecb bi\u1ebfn \u0111\u1ed5i theo tu\u1ed5i. Trong nh\u1eefng nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng, li\u1ec1u Trastuzumab kh\u00f4ng \u0111\u01b0\u1ee3c gi\u1ea3m \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n cao tu\u1ed5i.<\/p>\n<p><em>Tr\u1ebb em<\/em><\/p>\n<p>Hi\u1ec7u qu\u1ea3 v\u00e0 \u0111\u1ed9 an to\u00e0n c\u1ee7a Trastuzumab \u1edf c\u00e1c b\u1ec7nh nhi ch\u01b0a \u0111\u01b0\u1ee3c x\u00e1c \u0111\u1ecbnh.<\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<h2><span class=\"ez-toc-section\" id=\"43-chong-chi-dinh\"><\/span>4.3. Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Qu\u00e1 m\u1eabn v\u1edbi trastuzumab, protein t\u1eeb chu\u1ed9t, ho\u1eb7c b\u1ea5t k\u1ef3 th\u00e0nh ph\u1ea7n n\u00e0o c\u00f3 trong c\u00f4ng th\u1ee9c.<\/p>\n<p>Kh\u00f3 th\u1edf n\u1eb7ng k\u1ec3 c\u1ea3 khi \u1edf tr\u1ea1ng th\u00e1i ngh\u1ec9 ng\u01a1i (kh\u00f4ng v\u1eadn \u0111\u1ed9ng) do bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh ung th\u01b0 ti\u1ebfn tri\u1ec3n hay \u0111ang c\u1ea7n ph\u1ea3i \u0111i\u1ec1u tr\u1ecb oxy b\u1ed5 sung.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"44-than-trong\"><\/span>4.4 Th\u1eadn tr\u1ecdng:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Ch\u1ec9 n\u00ean \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Herticad d\u01b0\u1edbi s\u1ef1 gi\u00e1m s\u00e1t c\u1ee7a c\u00e1c b\u00e1c s\u0129 c\u00f3 kinh nghi\u1ec7m trong vi\u1ec7c \u0111i\u1ec1u tr\u1ecb c\u00e1c b\u1ec7nh nh\u00e2n ung th\u01b0.<\/p>\n<p>Nh\u1eefng ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i nghi\u00eam tr\u1ecdng c\u1ee7a vi\u1ec7c truy\u1ec1n Herticad bao g\u1ed3m kh\u00f3 th\u1edf, h\u1ea1 huy\u1ebft \u00e1p, kh\u00f2 kh\u00e8, co th\u1eaft ph\u1ebf qu\u1ea3n, nh\u1ecbp tim nhanh, gi\u1ea3m \u0111\u1ed9 b\u00e3o h\u00f2a oxy v\u00e0 suy h\u00f4 h\u1ea5p \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o tuy hi\u1ebfm g\u1eb7p. N\u00ean ng\u1eebng truy\u1ec1n Herticad v\u00e0 theo d\u00f5i b\u1ec7nh nh\u00e2n cho \u0111\u1ebfn khi lui nh\u1eefng tri\u1ec7u ch\u1ee9ng n\u00e0y. Nh\u1eefng ph\u1ea3n \u1ee9ng nghi\u00eam tr\u1ecdng \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb th\u00e0nh c\u00f4ng v\u1edbi nh\u1eefng li\u1ec7u ph\u00e1p h\u1ed7 tr\u1ee3 nh\u01b0 oxy, thu\u1ed1c ch\u1ee7 v\u1eadn beta v\u00e0 corticosteroids . Trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p hi\u1ebfm g\u1eb7p, nh\u1eefng ph\u1ea3n \u1ee9ng n\u00e0y c\u00f3 th\u1ec3 g\u00e2y t\u1eed vong. Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 kh\u00f3 th\u1edf khi ngh\u1ec9 ng\u01a1i do bi\u1ebfn ch\u1ee9ng c\u1ee7a b\u1ec7nh \u00e1c t\u00ednh ti\u1ebfn tri\u1ec3n hay b\u1ec7nh \u0111i k\u00e8m c\u00f3 th\u1ec3 b\u1ecb t\u0103ng nguy c\u01a1 ph\u1ea3n \u1ee9ng g\u00e2y t\u1eed vong do ti\u00eam truy\u1ec1n. Do \u0111\u00f3, ph\u1ea3i theo d\u00f5i nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y r\u1ea5t c\u1ea9n th\u1eadn v\u00e0 ph\u1ea3i c\u00e2n nh\u1eafc gi\u1eefa nguy c\u01a1 v\u00e0 l\u1ee3i \u00edch c\u1ee7a vi\u1ec7c d\u00f9ng thu\u1ed1c \u0111\u1ed1i v\u1edbi t\u1eebng b\u1ec7nh nh\u00e2n.<\/p>\n<p>C\u00e1c bi\u1ebfn c\u1ed1 v\u1ec1 \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p nghi\u00eam tr\u1ecdng c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o, tuy hi\u1ebfm g\u1eb7p, khi s\u1eed d\u1ee5ng Herticad sau khi thu\u1ed1c l\u01b0u h\u00e0nh tr\u00ean th\u1ecb tr\u01b0\u1eddng. C\u00e1c bi\u1ebfn c\u1ed1 hi\u1ebfm g\u1eb7p n\u00e0y \u0111\u00f4i khi g\u00e2y t\u1eed vong. Ngo\u00e0i ra, c\u00e1c tr\u01b0\u1eddng h\u1ee3p hi\u1ebfm g\u1eb7p nh\u01b0 th\u00e2m nhi\u1ec5m ph\u1ed5i, h\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p c\u1ea5p, vi\u00eam ph\u1ed5i nhi\u1ec5m tr\u00f9ng, vi\u00eam ph\u1ed5i, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, suy h\u00f4 h\u1ea5p, ph\u00f9 ph\u1ed5i c\u1ea5p v\u00e0 gi\u1ea3m ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o. C\u00e1c bi\u1ebfn c\u1ed1 n\u00e0y c\u00f3 th\u1ec3 x\u1ea3y ra trong l\u00fac truy\u1ec1n ho\u1eb7c xu\u1ea5t hi\u1ec7n mu\u1ed9n h\u01a1n. B\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh ph\u1ed5i n\u1ed9i t\u1ea1i c\u00f3 tri\u1ec7u ch\u1ee9ng ho\u1eb7c u lan t\u1ecfa \u1edf ph\u1ed5i, g\u00e2y kh\u00f3 th\u1edf khi ngh\u1ec9 ng\u01a1i, c\u00f3 th\u1ec3 c\u00f3 nguy c\u01a1 cao b\u1ecb c\u00e1c ph\u1ea3n \u1ee9ng nghi\u00eam tr\u1ecdng tr\u00ean.<\/p>\n<p>Suy tim (theo ph\u00e2n lo\u1ea1i c\u1ee7a H\u1ed9i Tim m\u1ea1ch New York [NYHA] t\u1eeb \u0111\u1ed9 II \u0111\u1ebfn \u0111\u1ed9 IV) \u0111\u01b0\u1ee3c ghi nh\u1eadn tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb v\u1edbi Herticad \u0111\u01a1n thu\u1ea7n hay k\u1ebft h\u1ee3p v\u1edbi paclitaxel sau khi s\u1eed d\u1ee5ng h\u00f3a tr\u1ecb li\u1ec7u bao g\u1ed3m anthracycline (doxorubicin ho\u1eb7c epirubicin). Suy tim c\u00f3 th\u1ec3 t\u1eeb trung b\u00ecnh \u0111\u1ebfn n\u1eb7ng v\u00e0 c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u1eed vong.<\/p>\n<p>N\u00ean th\u1eadn tr\u1ecdng khi \u0111i\u1ec1u tr\u1ecb cho nh\u1eefng b\u1ec7nh nh\u00e2n suy tim tri\u1ec7u ch\u1ee9ng, c\u00f3 ti\u1ec1n s\u1eed t\u0103ng huy\u1ebft \u00e1p, b\u1ec7nh m\u1ea1ch v\u00e0nh; v\u00e0 v\u1edbi ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm, n\u00ean th\u1eadn tr\u1ecdng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u l\u00e0 55% ho\u1eb7c \u00edt h\u01a1n. Nh\u1eefng ng\u01b0\u1eddi c\u00f3 ch\u1ec9 \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb Herticad, \u0111\u1eb7c bi\u1ec7t l\u00e0 nh\u1eefng ng\u01b0\u1eddi \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc \u0111\u00f3 v\u1edbi anthracycline v\u00e0 cyclophosphamide (AC), n\u00ean \u0111\u01b0\u1ee3c ki\u1ec3m tra tim m\u1ea1ch bao g\u1ed3m h\u1ecfi b\u1ec7nh s\u1eed v\u00e0 kh\u00e1m l\u00e2m s\u00e0ng, \u0111i\u1ec7n t\u00e2m \u0111\u1ed3 (ECG), si\u00eau \u00e2m tim, v\u00e0\/ho\u1eb7c MUGA scan. N\u00ean c\u00e2n nh\u1eafc c\u1ea9n th\u1eadn gi\u1eefa nguy c\u01a1 v\u00e0 l\u1ee3i \u00edch tr\u01b0\u1edbc khi quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Herticad.<\/p>\n<p>Trong ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm, th\u1eed nghi\u1ec7m HERA kh\u00f4ng bao g\u1ed3m nh\u1eefng b\u1ec7nh nh\u00e2n d\u01b0\u1edbi \u0111\u00e2y, v\u00ec v\u1eady kh\u00f4ng c\u00f3 \u0111\u1ee7 d\u1eef li\u1ec7u \u0111\u1ec3 c\u00e2n nh\u1eafc gi\u1eefa nguy c\u01a1 v\u00e0 l\u1ee3i \u00edch v\u00e0 do \u0111\u00f3 kh\u00f4ng n\u00ean \u0111i\u1ec1u tr\u1ecb Herticad cho nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y:<\/p>\n<p>C\u00f3 ti\u1ec1n s\u1eed b\u1ecb suy tim sung huy\u1ebft<\/p>\n<p>Lo\u1ea1n nh\u1ecbp tim nguy c\u01a1 cao kh\u00f4ng ki\u1ec3m so\u00e1t \u0111\u01b0\u1ee3c<\/p>\n<p>Ch\u1ee9ng \u0111au th\u1eaft ng\u1ef1c c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c<\/p>\n<p>B\u1ec7nh l\u00fd van tim c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t l\u00e2m s\u00e0ng<\/p>\n<p>C\u00f3 b\u1eb1ng ch\u1ee9ng c\u1ee7a nh\u1ed3i m\u00e1u xuy\u00ean v\u00e1ch tr\u00ean \u0111i\u1ec7n t\u00e2m \u0111\u1ed3<\/p>\n<p>Cao huy\u1ebft \u00e1p k\u00e9m \u0111\u00e1p \u1ee9ng v\u1edbi \u0111i\u1ec1u tr\u1ecb<\/p>\n<p>N\u00ean theo d\u00f5i th\u00eam v\u1ec1 ch\u1ee9c n\u0103ng tim khi \u0111i\u1ec1u tr\u1ecb (v\u00ed d\u1ee5 nh\u01b0 m\u1ed7i ba th\u00e1ng). Vi\u1ec7c theo d\u00f5i c\u00f3 th\u1ec3 gi\u00fap ph\u00e1t hi\u1ec7n nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tim.<\/p>\n<p>B\u1ec7nh nh\u00e2n c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tim nh\u01b0ng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 c\u1ea7n \u0111\u01b0\u1ee3c theo d\u00f5i th\u01b0\u1eddng xuy\u00ean h\u01a1n (v\u00ed d\u1ee5 m\u1ed7i 6-8 tu\u1ea7n). N\u1ebfu ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i ti\u1ebfp t\u1ee5c gi\u1ea3m, nh\u01b0ng v\u1eabn kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, th\u1ea7y thu\u1ed1c n\u00ean c\u00e2n nh\u1eafc kh\u1ea3 n\u0103ng ng\u1eebng thu\u1ed1c n\u1ebfu kh\u00f4ng th\u1ea5y l\u1ee3i \u00edch l\u00e2m s\u00e0ng c\u1ee7a Herticad. N\u1ebfu LVEF gi\u1ea3m10 \u0111i\u1ec3m ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u so v\u1edbi l\u00fac ban \u0111\u1ea7u v\u00e0 d\u01b0\u1edbi 50%, n\u00ean t\u1ea1m d\u1eebng Herticad v\u00e0 \u0111\u00e1nh gi\u00e1 l\u1ea1i LVEF trong kho\u1ea3ng 3 tu\u1ea7n. N\u1ebfu LVEF kh\u00f4ng \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n, ho\u1eb7c gi\u1ea3m nhi\u1ec1u h\u01a1n, n\u00ean ng\u1eebng s\u1eed d\u1ee5ng Herticad, tr\u1eeb khi l\u1ee3i \u00edch \u0111i\u1ec1u tr\u1ecb cho c\u1ee5 th\u1ec3 t\u1eebng b\u1ec7nh nh\u00e2n cao h\u01a1n h\u1eb3n nguy c\u01a1.<\/p>\n<p>N\u1ebfu suy tim c\u00f3 tri\u1ec7u ch\u1ee9ng x\u1ea3y ra khi \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Herticad, n\u00ean \u00e1p d\u1ee5ng nh\u1eefng ph\u01b0\u01a1ng ph\u00e1p \u0111i\u1ec1u tr\u1ecb chu\u1ea9n cho suy tim. N\u00ean ng\u1eebng \u0111i\u1ec1u tr\u1ecb Herticad \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 suy tim bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng tr\u1eeb khi l\u1ee3i \u00edch \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n cao h\u01a1n h\u1eb3n nguy c\u01a1.<\/p>\n<p>T\u00ednh an to\u00e0n c\u1ee7a vi\u1ec7c ti\u1ebfp t\u1ee5c ho\u1eb7c t\u00e1i \u0111i\u1ec1u tr\u1ecb Herticad cho nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb \u0111\u1ed9c t\u00ednh tim m\u1ea1ch ch\u01b0a \u0111\u01b0\u1ee3c kh\u1ea3o s\u00e1t m\u1ed9t c\u00e1ch ti\u1ec1n c\u1ee9u. Tuy nhi\u00ean, h\u1ea7u h\u1ebft nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb suy tim trong nh\u1eefng nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng then ch\u1ed1t \u0111\u1ec1u c\u1ea3i thi\u1ec7n v\u1edbi vi\u1ec7c \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa chu\u1ea9n. Ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb n\u00e0y bao g\u1ed3m thu\u1ed1c l\u1ee3i ti\u1ec3u, glycoside tr\u1ee3 tim, v\u00e0\/ho\u1eb7c c\u00e1c thu\u1ed1c \u1ee9c ch\u1ebf men chuy\u1ec3n angiotensin. \u0110a s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 tri\u1ec7u ch\u1ee9ng v\u1ec1 tim v\u00e0 c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 l\u1ee3i \u00edch l\u00e2m s\u00e0ng c\u1ee7a Herticad ti\u1ebfp t\u1ee5c \u0111i\u1ec1u tr\u1ecb Herticad m\u1ed7i tu\u1ea7n m\u00e0 kh\u00f4ng b\u1ecb th\u00eam m\u1ed9t bi\u1ebfn c\u1ed1 l\u00e2m s\u00e0ng n\u00e0o v\u1ec1 tim m\u1ea1ch.<\/p>\n<p><strong>T\u00e1c \u0111\u1ed9ng c\u1ee7a thu\u1ed1c tr\u00ean ng\u01b0\u1eddi l\u00e1i xe v\u00e0 v\u1eadn h\u00e0nh m\u00e1y m\u00f3c.<\/strong><\/p>\n<p>Theo c\u00e1c t\u00e0i li\u1ec7u \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1, trastuzumab kh\u00f4ng c\u00f3 ho\u1eb7c \u1ea3nh h\u01b0\u1edfng kh\u00f4ng \u0111\u00e1ng k\u1ec3 \u0111\u1ebfn kh\u1ea3 n\u0103ng l\u00e1i xe hay v\u1eadn h\u00e0nh m\u00e1y m\u00f3c.<\/p>\n<p>Tuy nhi\u00ean, b\u1ec7nh nh\u00e2n \u0111\u00e3 t\u1eebng b\u1ecb c\u00e1c tri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn truy\u1ec1n (xem TH\u1eacN TR\u1eccNG V\u00c0 C\u1ea2NH B\u00c1O) th\u00ec \u0111\u01b0\u1ee3c khuy\u00ean kh\u00f4ng n\u00ean l\u00e1i xe v\u00e0 v\u1eadn h\u00e0nh m\u00e1y m\u00f3c cho \u0111\u1ebfn khi c\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y gi\u1ea3m \u0111i.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"45-su-dung-cho-phu-nu-co-thai-va-cho-con-bu\"><\/span>4.5 S\u1eed d\u1ee5ng cho ph\u1ee5 n\u1eef c\u00f3 thai v\u00e0 cho con b\u00fa:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><em>X\u1ebfp h\u1ea1ng c\u1ea3nh b\u00e1o<\/em><\/p>\n<p>AU TGA pregnancy category: D<\/p>\n<p>US FDA pregnancy category: NA<\/p>\n<p><em>Th\u1eddi k\u1ef3 mang thai:<\/em><\/p>\n<p>N\u00ean tr\u00e1nh s\u1eed d\u1ee5ng trastuzumab khi c\u00f3 thai tr\u1eeb khi l\u1ee3i \u00edch cho ng\u01b0\u1eddi m\u1eb9 cao h\u01a1n h\u1eb3n c\u00e1c nguy c\u01a1 ti\u1ec1m t\u00e0ng cho thai. \u0110\u00e3 c\u00f3 b\u00e1o c\u00e1o sau khi thu\u1ed1c \u0111\u01b0\u1ee3c l\u01b0u h\u00e0nh v\u1ec1 t\u00ecnh tr\u1ea1ng thi\u1ec3u \u1ed1i \u1edf ph\u1ee5 n\u1eef c\u00f3 thai khi d\u00f9ng trastuzumab. Ng\u01b0\u1eddi ta kh\u00f4ng bi\u1ebft trastuzumab c\u00f3 g\u00e2y nguy h\u1ea1i cho thai hay kh\u00f4ng khi s\u1eed d\u1ee5ng tr\u00ean ph\u1ee5 n\u1eef c\u00f3 thai, ho\u1eb7c thu\u1ed1c c\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn kh\u1ea3 n\u0103ng sinh s\u1ea3n hay kh\u00f4ng. C\u00e1c nghi\u00ean c\u1ee9u tr\u00ean \u0111\u1ed9ng v\u1eadt cho th\u1ea5y kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng v\u1ec1 gi\u1ea3m kh\u1ea3 n\u0103ng sinh s\u1ea3n ho\u1eb7c g\u00e2y h\u1ea1i cho thai nhi.<\/p>\n<p><em>Kh\u1ea3 n\u0103ng sinh s\u1ea3n<\/em><\/p>\n<p>Hi\u1ec7n v\u1eabn ch\u01b0a c\u00f3 s\u1eb5n d\u1eef li\u1ec7u v\u1ec1 kh\u1ea3 n\u0103ng sinh s\u1ea3n trong c\u00e1c t\u00e0i li\u1ec7u \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1<\/p>\n<p><em>Th\u1eddi k\u1ef3 cho con b\u00fa:<\/em><\/p>\n<p>Ng\u01b0\u1eddi ta c\u0169ng kh\u00f4ng bi\u1ebft li\u1ec7u trastuzumab c\u00f3 ti\u1ebft qua s\u1eefa m\u1eb9 hay kh\u00f4ng. Do IgG ng\u01b0\u1eddi \u0111\u01b0\u1ee3c ti\u1ebft qua s\u1eefa m\u1eb9 v\u00e0 nh\u1eefng kh\u1ea3 n\u0103ng g\u00e2y h\u1ea1i v\u1edbi nh\u0169 nhi ch\u01b0a \u0111\u01b0\u1ee3c bi\u1ebft t\u1edbi, n\u00ean tr\u00e1nh cho con b\u00fa trong khi \u0111i\u1ec1u tr\u1ecb v\u1edbi trastuzumab.<\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<h2><span class=\"ez-toc-section\" id=\"46-tac-dung-khong-mong-muon-adr\"><\/span>4.6 T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n (ADR):<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>T\u1eeb c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng<\/p>\n<p><em>Ung th\u01b0 v\u00fa<\/em><\/p>\n<p><em>Ung th\u01b0 v\u00fa di c\u0103n<\/em><\/p>\n<p>B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Herticad \u0111\u01a1n tr\u1ecb ho\u1eb7c k\u1ebft h\u1ee3p v\u1edbi paclitaxel trong hai th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng then ch\u1ed1t, Kho\u1ea3ng 50% b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 b\u1ecb ph\u1ea3n \u1ee9ng kh\u00f4ng mong mu\u1ed1n th\u01b0\u1eddng g\u1eb7p nh\u1ea5t l\u00e0 nh\u1eefng tri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn ti\u00eam truy\u1ec1n nh\u01b0 s\u1ed1t v\u00e0 l\u1ea1nh run, th\u01b0\u1eddng x\u1ea3y ra sau l\u1ea7n truy\u1ec1n Herticad \u0111\u1ea7u ti\u00ean.<\/p>\n<p>C\u00e1c ph\u1ea3n \u1ee9ng kh\u00f4ng mong mu\u1ed1n \u0111\u01b0\u1ee3c qui cho Herticad x\u1ea3y ra trong s\u1ed1 &gt; 10% s\u1ed1 b\u1ec7nh nh\u00e2n trong hai nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng then ch\u1ed1t g\u1ed3m:<\/p>\n<p>To\u00e0n th\u00e2n: \u0111au b\u1ee5ng, suy nh\u01b0\u1ee3c, \u0111au ng\u1ef1c, \u1edbn l\u1ea1nh, s\u1ed1t, nh\u1ee9c \u0111\u1ea7u, \u0111au<\/p>\n<p>Ti\u00eau h\u00f3a: ti\u00eau ch\u1ea3y, bu\u1ed3n n\u00f4n, n\u00f4n<\/p>\n<p>C\u01a1 x\u01b0\u01a1ng: \u0111au kh\u1edbp, \u0111au c\u01a1<\/p>\n<p>Da v\u00e0 ph\u1ea7n ph\u1ee5: n\u1ed5i ban<\/p>\n<p>C\u00e1c ph\u1ea3n \u1ee9ng kh\u00f4ng mong mu\u1ed1n \u0111\u01b0\u1ee3c qui cho Herticad x\u1ea3y ra trong s\u1ed1 &gt; 1% v\u00e0 &lt; 10% b\u1ec7nh nh\u00e2n trong hai nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng then ch\u1ed1t g\u1ed3m:<\/p>\n<p>To\u00e0n th\u00e2n: \u0111au l\u01b0ng, b\u1ec7nh gi\u1ed1ng c\u00fam, nhi\u1ec5m tr\u00f9ng, \u0111au c\u1ed5, m\u1ec7t, ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn.<\/p>\n<p>Tim m\u1ea1ch: gi\u00e3n m\u1ea1ch, nh\u1ecbp tim nhanh tr\u00ean th\u1ea5t, h\u1ea1 huy\u1ebft \u00e1p, suy tim, b\u1ec7nh c\u01a1 tim, h\u1ed3i h\u1ed9p.<\/p>\n<p>Ti\u00eau h\u00f3a: bi\u1ebfng \u0103n, t\u00e1o b\u00f3n, kh\u00f3 ti\u00eau<\/p>\n<p>M\u00e1u v\u00e0 h\u1ea1ch b\u1ea1ch huy\u1ebft: gi\u1ea3m b\u1ea1ch c\u1ea7u<\/p>\n<p>Chuy\u1ec3n h\u00f3a: ph\u00f9 ngo\u1ea1i bi\u00ean, ph\u00f9<\/p>\n<p>C\u01a1 x\u01b0\u01a1ng: \u0111au x\u01b0\u01a1ng<\/p>\n<p>Th\u1ea7n kinh: lo \u00e2u, tr\u1ea7m c\u1ea3m, x\u00e2y x\u1ea9m, m\u1ea5t ng\u1ee7, d\u1ecb c\u1ea3m, ng\u1ee7 g\u00e0, t\u0103ng tr\u01b0\u01a1ng l\u1ef1c c\u01a1, b\u1ec7nh th\u1ea7n kinh ngo\u1ea1i bi\u00ean.<\/p>\n<p>H\u00f4 h\u1ea5p: hen, ho nhi\u1ec1u, kh\u00f3 th\u1edf, ch\u1ea3y m\u00e1u cam, b\u1ec7nh ph\u1ed5i, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, vi\u00eam h\u1ecdng, vi\u00eam m\u0169i, vi\u00eam xoang<\/p>\n<p>Ni\u1ec7u sinh d\u1ee5c: Nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ec3u<\/p>\n<p>Da v\u00e0 ph\u00e2n ph\u1ee5: Ng\u1ee9a, \u0111\u1ed5 m\u1ed3 h\u00f4i, b\u1ec7nh m\u00f3ng tay, da kh\u00f4, r\u1ee5ng t\u00f3c, m\u1ee5n tr\u1ee9ng c\u00e1, ban d\u00e1t s\u1ea9n<\/p>\n<p>Trong m\u1ed9t nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng ng\u1eabu nhi\u00ean kh\u00e1c, b\u1ec7nh nh\u00e2n b\u1ecb ung th\u01b0 v\u00fa di c\u0103n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb docetaxel \u0111\u01a1n tr\u1ecb ho\u1eb7c k\u1ebft h\u1ee3p Herticad. B\u1ea3ng d\u01b0\u1edbi \u0111\u00e2y cho th\u1ea5y c\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i kh\u00f4ng thu\u1ed9c v\u1ec1 huy\u1ebft h\u1ecdc th\u01b0\u1eddng g\u1eb7p, \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o trong s\u1ed1 &gt; 10% s\u1ed1 b\u1ec7nh nh\u00e2n, theo nh\u00f3m \u0111i\u1ec1u tr\u1ecb:<\/p>\n<p>B\u1ea3ng 3: C\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i kh\u00f4ng thu\u1ed9c v\u1ec1 huy\u1ebft h\u1ecdc th\u01b0\u1eddng g\u1eb7p, \u0111\u01b0\u1ee3c ghi nh\u1eadn &gt; 10% s\u1ed1 b\u1ec7nh nh\u00e2n, theo nh\u00f3m \u0111i\u1ec1u tr\u1ecb:<\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>H\u1ec7 th\u1ed1ng c\u01a1 th\u1ec3<\/strong><\/td>\n<td><strong>Bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i \u2022<\/strong><\/td>\n<td><strong>Herticad ph\u1ed1i h\u1ee3p v\u1edbi docetaxel N = 92 (%)<\/strong><\/td>\n<td><strong>Docetaxel N = 94 (%)<\/strong><\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c r\u1ed1i lo\u1ea1n to\u00e0n th\u00e2n v\u00e0 t\u00ecnh tr\u1ea1ng n\u01a1i ti\u00eam<\/em><\/td>\n<td>Suy nh\u01b0\u1ee3c Ph\u00f9 ngo\u1ea1i bi\u00ean M\u1ec7t m\u1ecfi Vi\u00eam ni\u00eam m\u1ea1c s\u1ed1t \u0110au Ng\u1ee7 l\u1ecbm \u0110au ng\u1ef1c B\u1ec7nh gi\u1ed1ng c\u00fam R\u00e9t run<\/td>\n<td>45 40 24 23 29 12 7 11 12 11<\/td>\n<td>41 35 21 22 15 9 1152 1<\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c r\u1ed1i lo\u1ea1n da v\u00e0 m\u00f4 d\u01b0\u1edbi da<\/em><\/td>\n<td>R\u1ee5ng t\u00f3c R\u1ed1i lo\u1ea1n m\u00f3ng Ph\u00e1t ban H\u1ed3ng ban<\/td>\n<td>67 17 24 23<\/td>\n<td>54 21 12 11<\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c r\u1ed1i lo\u1ea1n \u0111\u01b0\u1eddng ti\u00eau h\u00f3a<\/em><\/td>\n<td>Bu\u1ed3n n\u00f4n Ti\u00eau ch\u1ea3y N\u00f4n T\u00e1o b\u00f3n Vi\u00eam mi\u1ec7ng \u0110au b\u1ee5ng Kh\u00f3 ti\u00eau<\/td>\n<td>43 43 29 27 20 12 14<\/td>\n<td>41 36 22 23 14 125<\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c r\u1ed1i lo\u1ea1n h\u1ec7 th\u1ea7n kinh<\/em><\/td>\n<td>D\u1ecb c\u1ea3m \u0110au \u0111\u1ea7u Lo\u1ea1n v\u1ecb gi\u00e1c Gi\u1ea3m c\u1ea3m gi\u00e1c<\/td>\n<td>3221 14 11<\/td>\n<td>21 18 125<\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c r\u1ed1i lo\u1ea1n c\u01a1 x\u01b0\u01a1ng v\u00e0 m\u00f4 li\u00ean k\u1ebft<\/em><\/td>\n<td>\u0110au c\u01a1 \u0110au kh\u1edbp \u0110au \u1edf chi \u0110au l\u01b0ng \u0110au x\u01b0\u01a1ng<\/td>\n<td>27 27 16 10 14<\/td>\n<td>26 20 16 14 6<\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c r\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p, ng\u1ef1c v\u00e0 trung th\u1ea5t<\/em><\/td>\n<td>Ho Kh\u00f3 th\u1edf \u0110au h\u1ea7u h\u1ecdng Ch\u1ea3y m\u00e1u cam Ch\u1ea3y n\u01b0\u1edbc m\u0169i<\/td>\n<td>13 14 16 18 12<\/td>\n<td>16 15 9 5 1<\/td>\n<\/tr>\n<tr>\n<td><em>Nhi\u1ec5m tr\u00f9ng v\u00e0 nhi\u1ec5m k\u00fd sinh tr\u00f9ng<\/em><\/td>\n<td>Vi\u00eam m\u0169i h\u1ecdng<\/td>\n<td>15<\/td>\n<td>6<\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c r\u1ed1i lo\u1ea1n v\u1ec1 m\u1eaft<\/em><\/td>\n<td>T\u0103ng ti\u1ebft n\u01b0\u1edbc m\u1eaft Vi\u00eam k\u1ebft m\u1ea1c<\/td>\n<td>21 12<\/td>\n<td>107<\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c r\u1ed1i lo\u1ea1n m\u1ea1ch<\/em><\/td>\n<td>Ph\u00f9 m\u1ea1ch b\u1ea1ch huy\u1ebft<\/td>\n<td>11<\/td>\n<td>6<\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c r\u1ed1i lo\u1ea1n dinh d\u01b0\u1ee1ng v\u00e0 chuy\u1ec3n h\u00f3a<\/em><\/td>\n<td>Ch\u00e1n \u0103n<\/td>\n<td>22<\/td>\n<td>13<\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c ch\u1ec9 s\u1ed1 kh\u1ea3o s\u00e1t<\/em><\/td>\n<td>T\u0103ng c\u00e2n<\/td>\n<td>15<\/td>\n<td>6<\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c r\u1ed1i lo\u1ea1n v\u1ec1 t\u00e2m th\u1ea7n<\/em><\/td>\n<td>M\u1ea5t ng\u1ee7<\/td>\n<td>11<\/td>\n<td>4<\/td>\n<\/tr>\n<tr>\n<td><em>C\u00e1c bi\u1ebfn ch\u1ee9ng th\u01b0\u01a1ng t\u1eadt, nhi\u1ec5m \u0111\u1ed9c v\u00e0 th\u1ee7 thu\u1eadt<\/em><\/td>\n<td>Nhi\u1ec5m \u0111\u1ed9c m\u00f3ng<\/td>\n<td>11<\/td>\n<td>7<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Th\u1eed nghi\u1ec7m TAnDEM l\u00e0 m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean, nh\u00e3n m\u1edf, so s\u00e1nh gi\u1eefa li\u1ec7u ph\u00e1p anastrazole \u0111\u01a1n tr\u1ecb v\u00e0 anastrazole k\u1ebft h\u1ee3p v\u1edbi Herticad \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa di c\u0103n (xem ph\u1ea7n C\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng\/Hi\u1ec7u qu\u1ea3). Trong th\u1eed nghi\u1ec7m TAnDEM n\u00e0y, kh\u00f4ng c\u00f3 s\u1ef1 thay \u0111\u1ed5i v\u1ec1 m\u1eb7t b\u1ea3n ch\u1ea5t ho\u1eb7c t\u1ea7n su\u1ea5t c\u1ee7a nh\u1eefng bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i, khi so s\u00e1nh v\u1edbi nh\u1eefng th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng tr\u01b0\u1edbc \u0111\u00f3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb di c\u0103n.<\/p>\n<p><em>Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm<\/em><\/p>\n<p>Th\u1eed nghi\u1ec7m HERA l\u00e0 m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean, nh\u00e3n m\u1edf \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm c\u00f3 HER2 d\u01b0\u01a1ng t\u00ednh (xem ph\u1ea7n C\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng\/Hi\u1ec7u qu\u1ea3). B\u1ea3ng 4 cho th\u1ea5y c\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i \u0111\u01b0\u1ee3c ghi nh\u1eadn t\u1ea1i th\u1eddi \u0111i\u1ec3m m\u1ed9t n\u0103m tr\u00ean &gt; 1% s\u1ed1 b\u1ec7nh nh\u00e2n, theo nh\u00f3m \u0111i\u1ec1u tr\u1ecb<\/p>\n<p>B\u1ea3ng 4: C\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i \u0111\u01b0\u1ee3c ghi nh\u1eadn sau m\u1ed9t n\u0103m \u1edf &gt;1% s\u1ed1 b\u1ec7nh nh\u00e2n, theo nh\u00f3m \u0111i\u1ec1u tr\u1ecb<\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>h\u1ec7 th\u1ed1ng c\u01a1 th\u1ec3<\/strong><\/td>\n<td><strong>C\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i<\/strong><\/td>\n<td><strong>Nh\u00f3m ch\u1ee9ng N <\/strong>= <strong>1708 No. <\/strong>(%)<\/td>\n<td><strong>Nh\u00f3m d\u00f9ng Herticad trong 1 n\u0103m N <\/strong>= <strong>1678 No. <\/strong>(%)<\/td>\n<\/tr>\n<tr>\n<td>.<\/td>\n<td><strong>T\u1ed5ng s\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 \u00edt nh\u1ea5t m\u1ed9t bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i T\u1ed5ng s\u1ed1 c\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i<\/strong><\/td>\n<td><strong>792 (46) 2251<\/strong><\/td>\n<td><strong>1179 (70)5248<\/strong><\/td>\n<\/tr>\n<tr>\n<td>C\u00e1c r\u1ed1i lo\u1ea1n c\u01a1 x\u01b0\u01a1ng v\u00e0 m\u00f4 li\u00ean k\u1ebft<\/td>\n<td>\u0110au kh\u1edbp* \u0110au l\u01b0ng* \u0110au \u1edf chi \u0110au c\u01a1* \u0110au x\u01b0\u01a1ng \u0110au vai \u0110au th\u00e0nh ng\u1ef1c Co th\u1eaft c\u01a1* \u0110au c\u01a1 x\u01b0\u01a1ng<\/td>\n<td>98 (6) 59 (3) 45 (3) 17 (&lt; 1) 26 (2) 29 (2) 24 (1)3 (&lt;1)11 (&lt;1)<\/td>\n<td>137 (8) 91 (5) 60 (4) 63 (4) 49 (3) 30 (2) 26(2) 45 (3) 17 (1)<\/td>\n<\/tr>\n<tr>\n<td>Nhi\u1ec5m tr\u00f9ng v\u00e0 nhi\u1ec5m k\u00fd sinh tr\u00f9ng<\/td>\n<td>Vi\u00eam m\u0169i h\u1ecdng* C\u00fam* nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean* nhi\u1ec5m tr\u00f9ng \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u vi\u00eam m\u0169i vi\u00eam xoang vi\u00eam b\u00e0ng quang vi\u00eam h\u1ecdng vi\u00eam ph\u1ebf qu\u1ea3n herpes zoster<\/td>\n<td>43 (3) 9 (&lt; 1)20(1) 13 (&lt; 1) 6 (&lt; 1) 5 (&lt;1) 11 (&lt; 1) 9 (&lt; 1)9(&lt;1)9(&lt;1)<\/td>\n<td>135 (8) 69 (4) 46 (3) 39 (2) 36 (2) 26 (2) 19 (1) 20 (1) 18 (1) 17(1)<\/td>\n<\/tr>\n<tr>\n<td>C\u00e1c r\u1ed1i lo\u1ea1n to\u00e0n th\u00e2n v\u00e0 t\u00ecnh tr\u1ea1ng n\u01a1i ti\u00eam<\/td>\n<td>M\u1ec7t m\u1ecfi* Ph\u00f9 ngo\u1ea1i vi s\u1ed1t* Suy nh\u01b0\u1ee3c* \u1edbn l\u1ea1nh* \u0110au ng\u1ef1c* B\u1ec7nh c\u00fam Ph\u00f9 Kh\u00f3 ch\u1ecbu \u1edf ng\u1ef1c<\/td>\n<td>44 (3) 38 (2) 6 (&lt; 1) 30 (2) &#8211; 22 (1) 3 (&lt; 1) 7 (&lt; 1)2 (&lt; 1)<\/td>\n<td>128 (8) 79 (5) 100 (6) 75 (4) 85 (5) 45 (3) 40 (2) 18 (1) 20 (1)<\/td>\n<\/tr>\n<tr>\n<td>C\u00e1c r\u1ed1i lo\u1ea1n \u0111\u01b0\u1eddng ti\u00eau h\u00f3a<\/td>\n<td>Ti\u00eau ch\u1ea3y* Bu\u1ed3n n\u00f4n* n\u00f4n* \u0111au b\u1ee5ng t\u00e1o b\u00f3n \u0111au b\u1ee5ng tr\u00ean kh\u00f3 ti\u00eau vi\u00eam d\u1ea1 d\u00e0y vi\u00eam mi\u1ec7ng<\/td>\n<td>16 (&lt; 1) 19 (1) 10 (&lt; 1) 16 (&lt; 1) 17 (&lt;1) 15 (&lt; 1) 9 (&lt;1) 11 (&lt; 1) 1 (&lt; 1)<\/td>\n<td>123 (7) 108 (6) 58 (3) 40 (2) 33 (2) 29 (2) 30 (2) 20 (1) 26 (2)<\/td>\n<\/tr>\n<tr>\n<td>C\u00e1c r\u1ed1i lo\u1ea1n h\u1ec7 th\u1ea7n kinh<\/td>\n<td>\u0110au \u0111\u1ea7u* X\u00e2y x\u1ea9m* D\u1ecb c\u1ea3m Ch\u00f3ng m\u1eb7t<\/td>\n<td>49 (3) 29 (2) 11 (&lt; 1)7(&lt;1)<\/td>\n<td>161 (10) 60 (4) <em>l\u1ec1 <\/em>(2) 25(1)<\/td>\n<\/tr>\n<tr>\n<td>C\u00e1c r\u1ed1i lo\u1ea1n m\u1ea1ch m\u00e1u<\/td>\n<td>b\u1ed1c h\u1ecfa t\u0103ng huy\u1ebft \u00e1p* ph\u00f9 m\u1ea1ch b\u1ea1ch huy\u1ebft<\/td>\n<td>84 (5) 35 (2) 40 (2)<\/td>\n<td>98 (6) 64(4)42 (3)<\/td>\n<\/tr>\n<tr>\n<td>C\u00e1c r\u1ed1i lo\u1ea1n da v\u00e0 m\u00f4 d\u01b0\u1edbi da<\/td>\n<td>Ph\u00e1t ban* ng\u1ee9a* r\u1ed1i lo\u1ea1n m\u00f3ng r\u00f2n n\u1ebb m\u00f3ng ban \u0111\u1ecf<\/td>\n<td>10 (&lt; 1) 10 (&lt; 1)- 1(&lt;1)7(&lt;1)<\/td>\n<td>70 (4) 40 (2) 43 (3) 36 (2) 24(1)<\/td>\n<\/tr>\n<tr>\n<td>C\u00e1c r\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p, ng\u1ef1c v\u00e0 trung th\u1ea5t<\/td>\n<td>ho* kh\u00f3 th\u1edf \u0111au h\u1ea7u h\u1ecdng kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c s\u1ed5 m\u0169i ch\u1ea3y m\u00e1u cam<\/td>\n<td>34 (2) 26 (2) 8 (&lt; 1) 15 (&lt; 1) 5 (&lt; 1) 1 (&lt; 1)<\/td>\n<td>81 (5) 56 (3) 32 (2) 21 (1)24(1)24(1)<\/td>\n<\/tr>\n<tr>\n<td>C\u00e1c r\u1ed1i lo\u1ea1n h\u1ec7 sinh s\u1ea3n v\u00e0 v\u00fa<\/td>\n<td>\u0110au v\u00fa<\/td>\n<td>19(1)<\/td>\n<td>24(1)<\/td>\n<\/tr>\n<tr>\n<td>C\u00e1c r\u1ed1i lo\u1ea1n t\u00e2m th\u1ea7n<\/td>\n<td>M\u1ea5t ng\u1ee7 Tr\u1ea7m c\u1ea3m Lo l\u1eafng<\/td>\n<td>31 (2) 34 (2) 19(1)<\/td>\n<td>58 (3) 51 (3) 39 (2)<\/td>\n<\/tr>\n<tr>\n<td>C\u00e1c r\u1ed1i lo\u1ea1n tim m\u1ea1ch<\/td>\n<td>\u0110\u00e1nh tr\u1ed1ng ng\u1ef1c* Suy tim sung huy\u1ebft Nh\u1ecbp tim nhanh<\/td>\n<td>12 (&lt; 1) 5 (&lt; 1) 5 (&lt;1)<\/td>\n<td>48 (3) 30 (2) 20(1)<\/td>\n<\/tr>\n<tr>\n<td>C\u00e1c ch\u1ec9 s\u1ed1 kh\u1ea3o s\u00e1t<\/td>\n<td>Ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u gi\u1ea3m* T\u0103ng c\u00e2n<\/td>\n<td>11 (&lt; 1) 17 (&lt; 1)<\/td>\n<td>58 (3) 29 (2)<\/td>\n<\/tr>\n<tr>\n<td>C\u00e1c r\u1ed1i lo\u1ea1n th\u1eadn v\u00e0 \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u<\/td>\n<td>Ti\u1ec3u kh\u00f3<\/td>\n<td>2(&lt;1)<\/td>\n<td>17(1)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>* C\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf t\u1ec9 l\u1ec7 cao h\u01a1n (s\u1ef1 kh\u00e1c bi\u1ec7t &gt; 2%) trong nh\u00f3m Herticad so v\u1edbi nh\u00f3m ch\u1ee9ng v\u00e0 do v\u1eady c\u00f3 th\u1ec3 quy cho Herticad.<\/p>\n<p><em>Ung th\u01b0 d\u1ea1 d\u00e0y di c\u0103n<\/em><\/p>\n<p>Th\u1eed nghi\u1ec7m ToGA (B018255E) l\u00e0 m\u1ed9t th\u1eed nghi\u1ec7m pha III, \u0111a trung t\u00e2m, ng\u1eabu nhi\u00ean, nh\u00e3n m\u1edf so s\u00e1nh gi\u1eefa li\u1ec7u ph\u00e1p trastuzumab k\u1ebft h\u1ee3p v\u1edbi fluoropyrimidine v\u00e0 cisplatin v\u1edbi ho\u00e1 tr\u1ecb li\u1ec7u \u0111\u01a1n \u0111\u1ed9c \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u01b0\u1edbc \u0111\u1ea7u cho nh\u1eefng b\u1ec7nh nh\u00e2n ung th\u01b0 d\u1ea1 d\u00e0y di c\u0103n c\u00f3 HER2 d\u01b0\u01a1ng t\u00ednh. Bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i th\u01b0\u1eddng g\u1eb7p \u0111\u01b0\u1ee3c th\u1ec3 hi\u1ec7n \u1edf b\u1ea3ng 5.<\/p>\n<p>B\u1ea3ng 5: Bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i th\u01b0\u1eddng g\u1eb7p (T\u1ea5t c\u1ea3 c\u00e1c c\u1ea5p \u0111\u1ed9, t\u1ec9 l\u1ec7 \u00edt nh\u1ea5t 10%)<\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>H\u1ec7 th\u1ed1ng c\u01a1 th\u1ec3\/T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n<\/strong><\/td>\n<td><strong>Fluoropyrimidine\/Cisplatin (N = 290) No. (%)<\/strong><\/td>\n<td><strong>Trastuzumab\/FIuoropyrimidine\/CispIatin (N = 294) No. (%)<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>C\u00e1c r\u1ed1i lo\u1ea1n \u0111\u01b0\u1eddng ti\u00eau h\u00f3a<\/strong><\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Bu\u1ed3n n\u00f4n<\/td>\n<td>184 (63)<\/td>\n<td>197 (67)<\/td>\n<\/tr>\n<tr>\n<td>N\u00f4n<\/td>\n<td>134 (46)<\/td>\n<td>147 (50)<\/td>\n<\/tr>\n<tr>\n<td>Ti\u00eau ch\u1ea3y<\/td>\n<td>80 (28)<\/td>\n<td>109 (37)<\/td>\n<\/tr>\n<tr>\n<td>T\u00e1o b\u00f3n<\/td>\n<td>93 (32)<\/td>\n<td>75 (26)<\/td>\n<\/tr>\n<tr>\n<td>Vi\u00eam mi\u1ec7ng<\/td>\n<td>43 (15)<\/td>\n<td>72 (24)<\/td>\n<\/tr>\n<tr>\n<td>\u0110au b\u1ee5ng<\/td>\n<td>42(14)<\/td>\n<td>46(16)<\/td>\n<\/tr>\n<tr>\n<td><strong>R\u1ed1i lo\u1ea1n h\u1ec7 m\u00e1u v\u00e0 b\u1ea1ch huy\u1ebft<\/strong><\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh<\/td>\n<td>165 (57)<\/td>\n<td>157 (53)<\/td>\n<\/tr>\n<tr>\n<td>Thi\u1ebfu m\u00e1u<\/td>\n<td>61 (21)<\/td>\n<td>81 (28)<\/td>\n<\/tr>\n<tr>\n<td>Gi\u1ea3m ti\u1ec3u c\u1ea7u<\/td>\n<td>33(11)<\/td>\n<td>47(16)<\/td>\n<\/tr>\n<tr>\n<td><strong>C\u00e1c r\u1ed1i lo\u1ea1n chung v\u00e0 ph\u1ea3n \u1ee9ng t\u1ea1i n\u01a1i ti\u00eam<\/strong><\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>M\u1ec7t m\u1ecfi<\/td>\n<td>82 (28)<\/td>\n<td>102 (35)<\/td>\n<\/tr>\n<tr>\n<td>Suy nh\u01b0\u1ee3c<\/td>\n<td>53(18)<\/td>\n<td>55(19)<\/td>\n<\/tr>\n<tr>\n<td>S\u1ed1t<\/td>\n<td>36(12)<\/td>\n<td>54(18)<\/td>\n<\/tr>\n<tr>\n<td>Vi\u00eam m\u00e0ng nh\u00e0y<\/td>\n<td>18(6)<\/td>\n<td>37(13)<\/td>\n<\/tr>\n<tr>\n<td><strong>R\u1ed1i lo\u1ea1n dinh d\u01b0\u00f5ng v\u00e0 chuy\u1ec3n h\u00f3a<\/strong><\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Ch\u00e1n \u0103n<\/td>\n<td>133 (46)<\/td>\n<td>135 (46)<\/td>\n<\/tr>\n<tr>\n<td><strong>R\u1ed1i lo\u1ea1n da v\u00e0 m\u00f4 d\u01b0\u1edbi da<\/strong><\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>H\u1ed9i ch\u1ee9ng ban \u0111\u1ecf m\u1ea5t c\u1ea3m gi\u00e1c \u1edf l\u00f2ng b\u00e0n tay v\u00e0 b\u00e0n ch\u00e2n<\/td>\n<td>64 (22)<\/td>\n<td>75 (26)<\/td>\n<\/tr>\n<tr>\n<td>R\u1ee5ng t\u00f3c<\/td>\n<td>27 (9)<\/td>\n<td>32(11)<\/td>\n<\/tr>\n<tr>\n<td><strong>C\u00e1c ch\u1ec9 s\u1ed1 kh\u1ea3o s\u00e1t<\/strong><\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Gi\u1ea3m c\u00e2n<\/td>\n<td>40(14)<\/td>\n<td>69 (23)<\/td>\n<\/tr>\n<tr>\n<td><strong>R\u1ed1i lo\u1ea1n th\u1eadn v\u00e0 \u0111\u01b0\u1eddng ti\u1ebft ni\u1ec7u<\/strong><\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Suy th\u1eadn<\/td>\n<td>39(13)<\/td>\n<td>47(16)<\/td>\n<\/tr>\n<tr>\n<td><strong>C\u00e1c r\u1ed1i lo\u1ea1n h\u00f4 h\u1ea5p, ng\u1ef1c v\u00e0 trung th\u1ea5t<\/strong><\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>N\u1ea5c<\/td>\n<td>28(10)<\/td>\n<td>34(12)<\/td>\n<\/tr>\n<tr>\n<td><strong>C\u00e1c r\u1ed1i lo\u1ea1n h\u1ec7 th\u1ea7n kinh trung \u01b0\u01a1ng<\/strong><\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Ch\u00f3ng m\u1eb7t<\/td>\n<td>28(10)<\/td>\n<td>31(11)<\/td>\n<\/tr>\n<tr>\n<td><strong>Nhi\u1ec5m tr\u00f9ng v\u00e0 nhi\u1ec5m k\u00fd sinh tr\u00f9ng<\/strong><\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>Vi\u00eam m\u0169i h\u1ecdng<\/td>\n<td>17(6)<\/td>\n<td>37(13)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>.<\/p>\n<p><em>Th\u00f4ng tin d\u01b0\u1edbi \u0111\u00e2y li\u00ean quan \u0111\u1ebfn t\u1ea5t c\u1ea3 c\u00e1c ch\u1ec9 \u0111\u1ecbnh:<\/em><\/p>\n<p><em>C\u00e1c tri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn truy\u1ec1n<\/em><\/p>\n<p>Khi truy\u1ec1n Herticad l\u1ea7n \u0111\u1ea7u ti\u00ean, b\u1ec7nh nh\u00e2n th\u01b0\u1eddng b\u1ecb \u1edbn l\u1ea1nh v\u00e0\/ho\u1eb7c s\u1ed1t. Nh\u1eefng tri\u1ec7u ch\u1ee9ng v\u00e0\/ho\u1eb7c d\u1ea5u hi\u1ec7u kh\u00e1c c\u00f3 th\u1ec3 g\u1ed3m bu\u1ed3n n\u00f4n, n\u00f4n, \u0111au, l\u1ea1nh run, nh\u1ee9c \u0111\u1ea7u, ho, x\u00e2y x\u1ea9m, n\u1ed5i ban, suy nh\u01b0\u1ee3c, v\u00e0 t\u0103ng huy\u1ebft \u00e1p. C\u00e1c tri\u1ec7u ch\u1ee9ng n\u00e0y th\u01b0\u1eddng \u1edf m\u1ee9c \u0111\u1ed9 nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh, v\u00e0 \u00edt x\u1ea3y ra v\u1edbi nh\u1eefng l\u1ea7n truy\u1ec1n Herticad sau \u0111\u00f3. Nh\u1eefng tri\u1ec7u ch\u1ee9ng n\u00e0y c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c gi\u1ea3m \u0111au\/h\u1ea1 s\u1ed1t nh\u01b0 meperidine ho\u1eb7c paracetamol, ho\u1eb7c m\u1ed9t kh\u00e1ng histamine nh\u01b0 diphenhydramine (xem ph\u1ea7n Li\u1ec1u l\u01b0\u1ee3ng v\u00e0 c\u00e1ch d\u00f9ng). M\u1ed9t v\u00e0i ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i khi truy\u1ec1n Herticad bao g\u1ed3m kh\u00f3 th\u1edf, gi\u1ea3m huy\u1ebft \u00e1p, kh\u00f2 kh\u00e8, co th\u1eaft ph\u1ebf qu\u1ea3n, tim nh\u1ecbp nhanh, gi\u1ea3m \u0111\u1ed9 b\u00e3o h\u00f2a oxy v\u00e0 suy h\u00f4 h\u1ea5p, c\u00f3 th\u1ec3 nghi\u00eam tr\u1ecdng v\u00e0 c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y t\u1eed vong.<\/p>\n<p><em>C\u00e1c ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn<\/em><\/p>\n<p>C\u00e1c ph\u1ea3n \u1ee9ng ki\u1ec3u ph\u1ea3n v\u1ec7 \u0111\u00e3 \u0111\u01b0\u1ee3c quan s\u00e1t th\u1ea5y trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p ri\u00eang l\u1ebb.<\/p>\n<p><em>\u0110\u1ed9c t\u00ednh tr\u00ean tim<\/em><\/p>\n<p>Nh\u1eefng d\u1ea5u hi\u1ec7u v\u00e0 tri\u1ec7u ch\u1ee9ng c\u1ee7a r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tim nh\u01b0 kh\u00f3 th\u1edf, kh\u00f3 th\u1edf khi n\u1eb1m, h\u1ecd t\u0103ng l\u00ean, ph\u00f9 ph\u1ed5i, c\u00f3 ti\u1ebfng ng\u1ef1a phi T3 ho\u1eb7c gi\u1ea3m ph\u00e2n su\u1ea5t t\u1ed5ng m\u00e1u, \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi Herticad.<\/p>\n<p>D\u1ef1a v\u00e0o c\u00e1c ti\u00eau ch\u00ed \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng \u0111\u1ec3 x\u00e1c \u0111\u1ecbnh r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tim, trong c\u00e1c th\u1eed nghi\u1ec7m di c\u0103n then ch\u1ed1t t\u1ec9 l\u1ec7 b\u1ecb c\u00e1c r\u1ed1i lo\u1ea1n n\u00e0y thay \u0111\u1ed5i trong kho\u1ea3ng 9% \u0111\u1ebfn 12% trong ph\u00e2n nh\u00f3m \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Herticad + paclitaxel, so v\u1edbi 1% &#8211; 4% cho ph\u00e2n nh\u00f3m \u0111i\u1ec1u tr\u1ecb v\u1edbi paclitaxel \u0111\u01a1n thu\u1ea7n. V\u1edbi \u0111\u01a1n tr\u1ecb li\u1ec7u b\u1eb1ng Herticad, t\u1ec9 l\u1ec7 n\u00e0y l\u00e0 6% &#8211; 9%. T\u1ec9 l\u1ec7 b\u1ecb r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tim cao nh\u1ea5t g\u1eb7p \u1edf b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb Herticad + anthracycline\/cyclophosphamide (27% &#8211; 28%), cao h\u01a1n \u0111\u00e1ng k\u1ec3 so v\u1edbi t\u1ec9 l\u1ec7 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf b\u1ec7nh nh\u00e2n trong ph\u00e2n nh\u00f3m \u0111i\u1ec1u tr\u1ecb anthracycline\/cyclophosphamide \u0111\u01a1n thu\u1ea7n (7% &#8211; 10%). Trong m\u1ed9t th\u1eed nghi\u1ec7m sau \u0111\u00f3 c\u00f3 theo d\u00f5i ti\u00ean c\u1ee9u v\u1ec1 ch\u1ee9c n\u0103ng tim, t\u1ec9 l\u1ec7 suy tim c\u00f3 tri\u1ec7u ch\u1ee9ng l\u00e0 2,2% \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng Herticad v\u00e0 docetaxel, so v\u1edbi 0% \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng docetaxel \u0111\u01a1n thu\u1ea7n. Trong th\u1eed nghi\u1ec7m HERA, 0,6% s\u1ed1 b\u1ec7nh nh\u00e2n trong nh\u00f3m \u0111i\u1ec1u tr\u1ecb m\u1ed9t n\u0103m \u0111\u01b0\u1ee3c ghi nh\u1eadn c\u00f3 suy tim \u0111\u1ed9 III-IV theo ph\u00e2n lo\u1ea1i c\u1ee7a NYHA.<\/p>\n<p>Do th\u1eddi gian b\u00e1n th\u1ea3i trung b\u00ecnh cu\u1ed1i c\u00f9ng c\u1ee7a Herticad l\u00e0 28,5 ng\u00e0y (kho\u1ea3ng tin c\u1eady 95%: 25,5 &#8211; 32,8 ng\u00e0y), trastuzumab c\u00f3 th\u1ec3 c\u00f2n trong m\u00e1u cho \u0111\u1ebfn 20 tu\u1ea7n (kho\u1ea3ng tin c\u1eady 95%: 18-24 tu\u1ea7n) sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb. V\u00ec s\u1eed d\u1ee5ng anthracycline trong giai \u0111o\u1ea1n n\u00e0y c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn nguy c\u01a1 gia t\u0103ng b\u1ecb r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng tim, ngo\u00e0i vi\u1ec7c theo d\u00f5i ch\u1ee9c n\u0103ng tim c\u1ea9n th\u1eadn c\u00f2n c\u1ea7n ph\u1ea3i \u0111\u00e1nh gi\u00e1 k\u1ef9 l\u01b0\u1ee1ng v\u1ec1 c\u00e1c nguy c\u01a1 so v\u1edbi l\u1ee3i \u00edch khi \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p><em>Ung th\u01b0 d\u1ea1 d\u00e0y ti\u1ebfn tri\u1ec3n<\/em><\/p>\n<p>Trong th\u1eed nghi\u1ec7m ToGA, \u1edf th\u1eddi \u0111i\u1ec3m s\u00e0ng l\u1ecdc, gi\u00e1 tr\u1ecb LVEF trung v\u1ecb l\u00e0 64% (trong kho\u1ea3ng 48% &#8211; 90%) trong nh\u00f3m FP v\u00e0 65% (trong kho\u1ea3ng 50% &#8211; 86%) trong nh\u00f3m FP+H.<\/p>\n<p>Ph\u1ea7n l\u1edbn c\u00e1c tr\u01b0\u1eddng h\u1ee3p gi\u1ea3m LVEF trong th\u1eed nghi\u1ec7m ToGA l\u00e0 kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng, ngo\u1ea1i tr\u1eeb 1 b\u1ec7nh nh\u00e2n trong nh\u00f3m d\u00f9ng Herticad gi\u1ea3m LVEF tr\u00f9ng v\u1edbi suy tim.<\/p>\n<p>T\u00f3m t\u1eaft s\u1ef1 thay \u0111\u1ed5i LVEF t\u1eeb th\u1eddi \u0111i\u1ec3m s\u00e0ng l\u1ecdc<\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>Gi\u1ea3m LVEF: Gi\u00e1 tr\u1ecb th\u1ea5p nh\u1ea5t sau s\u00e0ng l\u1ecdc<br \/>\n<\/strong><\/td>\n<td><strong>Gi\u1ea3m LVEF: Gi\u00e1 tr\u1ecb th\u1ea5p nh\u1ea5t sau s\u00e0ng l\u1ecdc<\/strong><\/td>\n<td><strong>Trastuzumab\/Fluoropyrimidine\/Cisplatin (N = 294) (% b\u1ec7nh nh\u00e2n trong m\u1ed7i nh\u00f3m \u0111i\u1ec1u tr\u1ecb)<\/strong><\/td>\n<\/tr>\n<tr>\n<td><strong>* <\/strong>Gi\u1ea3m LVEF &gt; 10% t\u1edbi gi\u00e1 tr\u1ecb <strong>&lt; <\/strong>50%<\/td>\n<td>1.10%<\/td>\n<td>4.60%<\/td>\n<\/tr>\n<tr>\n<td>Gi\u00e1 tr\u1ecb tuy\u1ec7t \u0111\u1ed1i &lt; 50%<\/td>\n<td>1.10%<\/td>\n<td>5.90%<\/td>\n<\/tr>\n<tr>\n<td>*Gi\u1ea3m LVEF &gt; 10% t\u1edbi gi\u00e1<br \/>\ntr\u1ecb &gt; 50%<\/td>\n<td>11.80%<\/td>\n<td>16.50%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>* Ch\u1ec9 bao g\u1ed3m nh\u1eefng b\u1ec7nh nh\u00e2n m\u00e0 ph\u01b0\u01a1ng ph\u00e1p \u0111\u00e1nh gi\u00e1 \u1edf th\u1eddi \u0111i\u1ec3m th\u0103m kh\u00e1m gi\u1ed1ng c\u00e1c \u0111\u00e1nh gi\u00e1 \u1edf th\u1eddi \u0111i\u1ec3m ban \u0111\u1ea7u (F + C, n = 187 v\u00e0 H+ FC, n = 237)<\/p>\n<p>C\u00e1c t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n tr\u00ean tim<\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>.<\/strong><\/td>\n<td><strong>Fluoropyrimidine\/CispIatin (N = 290) (% b\u1ec7nh nh\u00e2n trong m\u1ed7i nh\u00f3m \u0111i\u1ec1u tr\u1ecb)<\/strong><\/td>\n<td><strong>Trastuzumab\/Fluoropyrimidine\/CispIatin (N = 294) (% b\u1ec7nh nh\u00e2n trong m\u1ed7i nh\u00f3m \u0111i\u1ec1u tr\u1ecb)<\/strong><\/td>\n<\/tr>\n<tr>\n<td>T\u1ed5ng s\u1ed1 c\u00e1c bi\u1ebfn c\u1ed1 tr\u00ean tim<\/td>\n<td>6%<\/td>\n<td>6%<\/td>\n<\/tr>\n<tr>\n<td>&gt; \u0110\u1ed9 3 NCICTCAE V3.0<\/td>\n<td>*3%<\/td>\n<td>**1%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>* 9 b\u1ec7nh nh\u00e2n tr\u1ea3i qua 9 bi\u1ebfn c\u1ed1<\/p>\n<p>* * 4 b\u1ec7nh nh\u00e2n tr\u1ea3i qua 4 bi\u1ebfn c\u1ed1<\/p>\n<p>T\u00f3m l\u1ea1i, kh\u00f4ng ghi nh\u1eadn s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a v\u1ec1 \u0111\u1ed9c t\u00ednh tr\u00ean tim gi\u1eefa nh\u00f3m \u0111i\u1ec1u tr\u1ecb v\u00e0 nh\u00f3m so s\u00e1nh.<\/p>\n<p><em>\u0110\u1ed9c t\u00ednh v\u1ec1 huy\u1ebft h\u1ecdc<\/em><\/p>\n<p><em>Ung th\u01b0 v\u00fa<\/em><\/p>\n<p>\u0110\u1ed9c t\u00ednh v\u1ec1 huy\u1ebft h\u1ecdc \u00edt khi x\u1ea3y ra khi s\u1eed d\u1ee5ng Herticad \u0111\u01a1n tr\u1ecb trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 di c\u0103n, gi\u1ea3m b\u1ea1ch c\u1ea7u, gi\u1ea3m ti\u1ec3u c\u1ea7u v\u00e0 thi\u1ebfu m\u00e1u \u0111\u1ed9 III theo ph\u00e2n lo\u1ea1i c\u1ee7a T\u1ed5 ch\u1ee9c Y t\u1ebf Th\u1ebf Gi\u1edbi (TCYTTG), x\u1ea3y ra trong s\u1ed1 &lt; 1% b\u1ec7nh nh\u00e2n. Kh\u00f4ng th\u1ea5y \u0111\u1ed9c t\u00ednh \u0111\u1ed9 IV theo ph\u00e2n lo\u1ea1i c\u1ee7a TCYTTG. C\u00f3 s\u1ef1 gia t\u0103ng \u0111\u1ed9c t\u00ednh huy\u1ebft h\u1ecdc \u0111\u1ed9 III ho\u1eb7c \u0111\u1ed9 IV theo ph\u00e2n lo\u1ea1i c\u1ee7a TCYTTG \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p Herticad v\u00e0 paclitaxel so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n ch\u1ec9 \u0111i\u1ec1u tr\u1ecb paclitaxel \u0111\u01a1n thu\u1ea7n (34% so v\u1edbi 21%). \u0110\u1ed9c t\u00ednh v\u1ec1 huy\u1ebft h\u1ecdc c\u0169ng t\u0103ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n d\u00f9ng Herticad v\u00e0 docetaxel, so v\u1edbi docetaxel \u0111\u01a1n thu\u1ea7n (32% gi\u1ea3m b\u1ea1ch c\u1ea7u \u0111\u1ed9 3\/4 so v\u1edbi 22%, \u00e1p d\u1ee5ng ti\u00eau ch\u00ed NCI-CTC). T\u1ec9 l\u1ec7 s\u1ed1t do gi\u1ea3m b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh\/ nhi\u1ec5m tr\u00f9ng huy\u1ebft do gi\u1ea3m b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh c\u0169ng t\u0103ng nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi Herticad c\u00f9ng docetaxel (23% so v\u1edbi 17% cho nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng docetaxel \u0111\u01a1n thu\u1ea7n).<\/p>\n<p>\u00c1p d\u1ee5ng ti\u00eau ch\u00ed NCI-CTC, trong th\u1eed nghi\u1ec7m HERA, 0,4% b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Herticad c\u00f3 thay \u0111\u1ed5i \u0111\u1ed9 III ho\u1eb7c IV so v\u1edbi l\u00fac ban \u0111\u1ea7u, So v\u1edbi 0,6% trong nh\u00f3m ch\u1ee9ng.<\/p>\n<p><em>Ung th\u01b0 d\u1ea1 d\u00e0y ti\u1ebfn tri\u1ec3n<\/em><\/p>\n<p>C\u00e1c bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i n\u1eb1m trong m\u1ee5c R\u1ed1i lo\u1ea1n h\u1ec7 m\u00e1u v\u00e0 b\u1ea1ch huy\u1ebft m\u00e0 \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o th\u01b0\u1eddng xuy\u00ean nh\u1ea5t, \u0110\u1ed9 &gt;3 v\u00e0 x\u1ea3y ra v\u1edbi t\u1ec9 l\u1ec7 \u00edt nh\u1ea5t 1% do \u0111i\u1ec1u tr\u1ecb trong th\u1eed nghi\u1ec7m \u0111\u01b0\u1ee3c ch\u1ec9 ra d\u01b0\u1edbi \u0111\u00e2y:<\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>.<\/strong><\/td>\n<td><strong>FIuoropyrimidine\/Cisplatin (N = 290) (% b\u1ec7nh nh\u00e2n trong m\u1ed7i nh\u00f3m \u0111i\u1ec1u tr\u1ecb)<\/strong><\/td>\n<td><strong>Trastuzumab\/Fluoropyrimidine\/Cisplatin (N = 294) (% b\u1ec7nh nh\u00e2n trong m\u1ed7i nh\u00f3m \u0111i\u1ec1u tr\u1ecb)<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh<\/td>\n<td>30%<\/td>\n<td>27%<\/td>\n<\/tr>\n<tr>\n<td>Thi\u1ebfu m\u00e1u<\/td>\n<td>10%<\/td>\n<td>12%<\/td>\n<\/tr>\n<tr>\n<td>Gi\u1ea3m b\u1ea1ch c\u1ea7u trung t\u00ednh c\u00f3 s\u1ed1t<\/td>\n<td>3%<\/td>\n<td>5%<\/td>\n<\/tr>\n<tr>\n<td>Gi\u1ea3m ti\u1ec3u c\u1ea7u<\/td>\n<td>3%<\/td>\n<td>5%<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>T\u1ed5ng s\u1ed1 ph\u1ea7n tr\u0103m b\u1ec7nh nh\u00e2n c\u00f3 1 bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i &gt; \u0110\u1ed9 3 theo NCI CTCAE v3.0 m\u00e0 \u0111\u01b0\u1ee3c ph\u00e2n lo\u1ea1i theo Ph\u00e2n lo\u1ea1i c\u01a1 quan h\u1ec7 th\u1ed1ng (SOC) n\u00e0y l\u00e0 38% trong nh\u00f3m FP v\u00e0 40% trong nh\u00f3m FP+H. N\u00f3i chung, kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t c\u00f3 \u00fd ngh\u0129a v\u1ec1 \u0111\u1ed9c t\u00ednh huy\u1ebft h\u1ecdc gi\u1eefa nh\u00f3m \u0111i\u1ec1u tr\u1ecb v\u00e0 nh\u00f3m so s\u00e1nh.<\/p>\n<p><em>\u0110\u1ed9c t\u00ednh tr\u00ean gan v\u00e0 th\u1eadn<\/em><\/p>\n<p>\u0110\u1ed9c t\u00ednh tr\u00ean gan \u0111\u1ed9 III ho\u1eb7c \u0111\u1ed9 IV theo ph\u00e2n lo\u1ea1i c\u1ee7a TCYTTG \u0111\u01b0\u1ee3c ghi nh\u1eadn trong 1% b\u1ec7nh nh\u00e2n sau khi d\u00f9ng Herticad \u0111\u01a1n tr\u1ecb, trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 di c\u0103n. \u0110\u1ed9c t\u00ednh n\u00e0y li\u00ean quan \u0111\u1ebfn s\u1ef1 ti\u1ebfn tri\u1ec3n b\u1ec7nh t\u1ea1i gan trong s\u1ed1 60% b\u1ec7nh nh\u00e2n.<\/p>\n<p>\u0110\u1ed9c t\u00ednh tr\u00ean gan \u0111\u1ed9 III ho\u1eb7c \u0111\u1ed9 IV theo TCYTTG \u00edt g\u1eb7p h\u01a1n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p Herticad v\u00e0 paclitaxel so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng paclitaxel \u0111\u01a1n thu\u1ea7n (7% so v\u1edbi 15%). Ch\u01b0a ghi nh\u1eadn \u0111\u1ed9c t\u00ednh tr\u00ean th\u1eadn \u0111\u1ed9 III ho\u1eb7c \u0111\u1ed9 IV theo ph\u00e2n lo\u1ea1i c\u1ee7a TCYTTG.<\/p>\n<p><em>Ung th\u01b0 d\u1ea1 d\u00e0y ti\u1ebfn tri\u1ec3n<\/em><\/p>\n<p>Trong th\u1eed nghi\u1ec7m ToGA, kh\u00f4ng ghi nh\u1eadn s\u1ef1 kh\u00e1c nhau c\u00f3 \u00fd ngh\u0129a v\u1ec1 \u0111\u1ed9c t\u00ednh t\u1ea1i gan v\u00e0 th\u1eadn gi\u1eefa hai nh\u00f3m \u0111i\u1ec1u tr\u1ecb.<\/p>\n<p>\u0110\u1ed9c t\u00ednh t\u1ea1i th\u1eadn &gt; \u0110\u1ed9 3 theo NCI CTCAE v3.0 kh\u00f4ng cao h\u01a1n m\u1ed9t c\u00e1ch c\u00f3 \u00fd ngh\u0129a \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Herticad so v\u1edbi nh\u00f3m b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng F+P (t\u01b0\u01a1ng \u1ee9ng l\u00e0 3% v\u00e0 2%).<\/p>\n<p>Bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i &gt; \u0110\u1ed9 3 theo NCI CTCAE v3.0 trong c\u00e1c r\u1ed1i lo\u1ea1n h\u1ec7 gan m\u1eadt: T\u0103ng bilirubin huy\u1ebft l\u00e0 bi\u1ebfn c\u1ed1 b\u1ea5t l\u1ee3i duy nh\u1ea5t \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o v\u00e0 kh\u00f4ng cao h\u01a1n m\u1ed9t c\u00e1ch c\u00f3 \u00fd ngh\u0129a \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Herticad so v\u1edbi nh\u00f3m b\u1ec7nh nh\u00e2n \u0111i\u1ec1u tr\u1ecb b\u1eb1ng F4P (t\u01b0\u01a1ng \u1ee9ng l\u00e0 1% v\u00e0 &lt; 1%).<\/p>\n<p><em>Ti\u00eau ch\u1ea3y<\/em><\/p>\n<p><em>Ung th\u01b0 v\u00fa<\/em><\/p>\n<p>Trong s\u1ed1 c\u00e1c b\u1ec7nh nh\u00e2n d\u00f9ng Herticad \u0111\u01a1n tr\u1ecb trong b\u1ec7nh c\u1ea3nh di c\u0103n, 27% s\u1ed1 b\u1ec7nh nh\u00e2n b\u1ecb ti\u00eau ch\u1ea3y. Ng\u01b0\u1eddi ta c\u0169ng ghi nh\u1eadn t\u0103ng t\u1ec9 l\u1ec7 ti\u00eau ch\u1ea3y, th\u01b0\u1eddng \u1edf m\u1ee9c \u0111\u1ed9 t\u1eeb nh\u1eb9 \u0111\u1ebfn trung b\u00ecnh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb Herticad k\u1ebft h\u1ee3p v\u1edbi paclitaxel so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng paclitaxel \u0111\u01a1n thu\u1ea7n.<\/p>\n<p>Trong th\u1eed nghi\u1ec7m HERA, 7% s\u1ed1 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Herticad b\u1ecb ti\u00eau ch\u1ea3y.<\/p>\n<p><em>Ung th\u01b0 d\u1ea1 d\u00e0y ti\u1ebfn tri\u1ec3n<\/em><\/p>\n<p>Trong th\u1eed nghi\u1ec7m ToGA, 100 b\u1ec7nh nh\u00e2n (37%) tham gia v\u00e0o nh\u00f3m \u0111i\u1ec1u tr\u1ecb c\u00f3 d\u00f9ng Herticad so v\u1edbi 80 b\u1ec7nh nh\u00e2n (28%) \u1edf nh\u00f3m so s\u00e1nh \u0111\u1ec1u ghi nh\u1eadn ti\u00eau ch\u1ea3y \u1edf b\u1ea5t c\u1ee9 c\u1ea5p \u0111\u1ed9 n\u00e0o. \u00c1p d\u1ee5ng ti\u00eau chu\u1ea9n m\u1ee9c \u0111\u1ed9 theo NCI-CTCAE v3.0, ph\u1ea7n tr\u0103m b\u1ec7nh nh\u00e2n b\u1ecb ti\u00eau ch\u1ea3y &gt; \u0110\u1ed9 3 l\u00e0 4% \u1edf nh\u00f3m FP v\u00e0 9% \u1edf nh\u00f3m FP+H.<\/p>\n<p><em>Nhi\u1ec5m tr\u00f9ng<\/em><\/p>\n<p>Ng\u01b0\u1eddi ta c\u0169ng th\u1ea5y c\u00f3 t\u0103ng t\u1ec9 l\u1ec7 nhi\u1ec5m tr\u00f9ng, ch\u1ee7 y\u1ebfu l\u00e0 nhi\u1ec5m tr\u00f9ng nh\u1eb9 \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p tr\u00ean \u00edt c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng ho\u1eb7c nhi\u1ec5m tr\u00f9ng \u1ed1ng th\u00f4ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi Herticad.<\/p>\n<p>C\u00e1c ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i nghi\u00eam tr\u1ecdng<\/p>\n<p>C\u00f3 \u00edt nh\u1ea5t m\u1ed9t tr\u01b0\u1eddng h\u1ee3p trong s\u1ed1 c\u00e1c ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i nghi\u00eam tr\u1ecdng sau \u0111\u00e2y \u0111\u00e3 x\u1ea3y ra \u1edf \u00edt nh\u1ea5t m\u1ed9t b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng Herticad \u0111\u01a1n thu\u1ea7n ho\u1eb7c ph\u1ed1i h\u1ee3p v\u1edbi h\u00f3a tr\u1ecb trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng:<\/p>\n<p>To\u00e0n th\u00e2n: ph\u1ea3n \u1ee9ng qu\u00e1 m\u1eabn, ph\u1ea3n v\u1ec7 v\u00e0 cho\u00e1ng ph\u1ea3n v\u1ec7, m\u1ea5t \u0111i\u1ec1u v\u1eadn, nhi\u1ec5m tr\u00f9ng huy\u1ebft, \u1edbn l\u1ea1nh v\u00e0 s\u1ed1t, suy nh\u01b0\u1ee3c, s\u1ed1t, r\u00e9t run, \u0111au \u0111\u1ea7u, li\u1ec7t nh\u1eb9, \u0111au ng\u1ef1c, m\u1ec7t m\u1ecfi<\/p>\n<p>Tim m\u1ea1ch: b\u1ec7nh c\u01a1 tim, suy tim sung huy\u1ebft, suy tim sung huy\u1ebft n\u1eb7ng l\u00ean, gi\u1ea3m ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u, gi\u1ea3m huy\u1ebft \u00e1p, tr\u00e0n d\u1ecbch m\u00e0ng tim, nh\u1ecbp tim ch\u1eadm, b\u1ec7nh m\u1ea1ch m\u00e1u n\u00e3o<\/p>\n<p>Ti\u00eau h\u00f3a: h\u1ee7y ho\u1ea1i t\u1ebf b\u00e0o gan, ti\u00eau ch\u1ea3y, bu\u1ed3n n\u00f4n v\u00e0 n\u00f4n<\/p>\n<p>M\u00e1u v\u00e0 h\u1ea1ch b\u1ea1ch huy\u1ebft: b\u1ec7nh b\u1ea1ch c\u1ea7u, s\u1ed1t do gi\u1ea3m b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh, gi\u1ea3m b\u1ea1ch c\u1ea7u \u0111a nh\u00e2n trung t\u00ednh, gi\u1ea3m ti\u1ec3u c\u1ea7u<\/p>\n<p>Nhi\u1ec5m tr\u00f9ng: vi\u00eam m\u00f4 t\u1ebf b\u00e0o, vi\u00eam qu\u1ea7ng<\/p>\n<p>H\u00f4 h\u1ea5p: co th\u1eaft ph\u1ebf qu\u1ea3n, suy h\u00f4 h\u1ea5p, ph\u00f9 ph\u1ed5i c\u1ea5p, gi\u1ea3m ch\u1ee9c n\u0103ng h\u00f4 h\u1ea5p<\/p>\n<p>Da v\u00e0 ph\u1ea7n ph\u1ee5 d\u01b0\u1edbi da: n\u1ed5i ban<\/p>\n<p><em>C\u00e1c b\u1ea5t th\u01b0\u1eddng v\u1ec1 x\u00e9t nghi\u1ec7m<\/em><\/p>\n<p>Tham kh\u1ea3o ph\u1ea7n t\u1eeb c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng<\/p>\n<p><em>Sau khi l\u01b0u h\u00e0nh<\/em><\/p>\n<p>\u0110\u00e3 c\u00f3 th\u00eam c\u00e1c ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i nghi\u00eam tr\u1ecdng d\u01b0\u1edbi \u0111\u00e2y \u0111\u01b0\u1ee3c b\u00e1o c\u00e1o \u1edf \u00edt nh\u1ea5t m\u1ed9t b\u1ec7nh nh\u00e2n sau khi thu\u1ed1c l\u01b0u h\u00e0nh tr\u00ean th\u1ecb tr\u01b0\u1eddng:<\/p>\n<p>To\u00e0n th\u00e2n: c\u00e1c tri\u1ec7u ch\u1ee9ng li\u00ean quan \u0111\u1ebfn ti\u00eam truy\u1ec1n, ph\u00f9 ngo\u1ea1i vi, \u0111au x\u01b0\u01a1ng, h\u00f4n m\u00ea, vi\u00eam m\u00e0ng n\u00e3o, ph\u00f9 n\u00e3o, t\u01b0 duy b\u1ea5t th\u01b0\u1eddng.<\/p>\n<p>Tim m\u1ea1ch: suy tim, cho\u00e1ng tim, vi\u00eam m\u00e0ng ngo\u00e0i tim, t\u0103ng huy\u1ebft \u00e1p<\/p>\n<p>Ti\u00eau h\u00f3a: vi\u00eam t\u1ee5y c\u1ea5p, suy gan, v\u00e0ng da.<\/p>\n<p>M\u00e1u v\u00e0 h\u1ea1ch b\u1ea1ch huy\u1ebft: thi\u1ebfu m\u00e1u, gi\u1ea3m prothrombin huy\u1ebft.<\/p>\n<p>C\u01a1 x\u01b0\u01a1ng kh\u1edbp: \u0111au c\u01a1.<\/p>\n<p>H\u00f4 h\u1ea5p: kh\u00f3 th\u1edf, gi\u1ea3m oxy m\u00e1u, ph\u00f9 thanh qu\u1ea3n, suy h\u00f4 h\u1ea5p c\u1ea5p, h\u1ed9i ch\u1ee9ng suy h\u00f4 h\u1ea5p \u1edf ng\u01b0\u1eddi tr\u01b0\u1edfng th\u00e0nh, tr\u00e0n d\u1ecbch m\u00e0ng ph\u1ed5i, th\u00e2m nhi\u1ec5m ph\u1ed5i, vi\u00eam ph\u1ed5i nhi\u1ec5m tr\u00f9ng, vi\u00eam ph\u1ed5i, x\u01a1 h\u00f3a ph\u1ed5i.<\/p>\n<p>Th\u1eadn: b\u1ec7nh th\u1eadn &#8211; ti\u1ec3u c\u1ea7u th\u1eadn, suy th\u1eadn<\/p>\n<p>Da v\u00e0 ph\u00e2n ph\u1ee5: vi\u00eam da, n\u1ed5i m\u1ec1 \u0111ay.<\/p>\n<p>C\u00e1c gi\u00e1c quan: \u0111i\u1ebfc.<\/p>\n<p><em>Th\u00f4ng b\u00e1o cho B\u00e1c s\u0129 nh\u1eefng t\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n g\u1eb7p ph\u1ea3i khi s\u1eed d\u1ee5ng thu\u1ed1c.<\/em><\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<h2><span class=\"ez-toc-section\" id=\"47-huong-dan-cach-xu-tri-adr\"><\/span>4.7 H\u01b0\u1edbng d\u1eabn c\u00e1ch x\u1eed tr\u00ed ADR:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>T\u1ea1m ng\u1eebng ho\u1eb7c ng\u1eebng h\u1eb3n trastuzumab n\u1ebfu b\u1ec7nh nh\u00e2n b\u1ecb ADR n\u1eb7ng ho\u1eb7c ADR nguy hi\u1ec3m t\u1edbi t\u00ednh m\u1ea1ng.<\/p>\n<p>X\u1eed tr\u00ed ADR ch\u1ee7 y\u1ebfu l\u00e0 \u0111i\u1ec1u tr\u1ecb tri\u1ec7u ch\u1ee9ng, \u0111i\u1ec1u tr\u1ecb h\u1ed7 tr\u1ee3 v\u00e0 can thi\u1ec7p t\u00f9y theo t\u1eebng tr\u01b0\u1eddng h\u1ee3p m\u1eafc.<\/p>\n<p>\u0110\u1eb7t \u1ed1ng n\u1ed9i kh\u00ed qu\u1ea3n n\u1ebfu b\u1ecb t\u00e1c d\u1ee5ng c\u00e1c ph\u1ea3n \u1ee9ng l\u00ean \u0111\u01b0\u1eddng h\u00f4 h\u1ea5p do truy\u1ec1n thu\u1ed1c (suy h\u00f4 h\u1ea5p c\u1ea5p, \u1ee9c ch\u1ebf trung t\u00e2m th\u1ea7n kinh). Ph\u1ea3n \u1ee9ng ph\u1ea3n v\u1ec7: D\u00f9ng kh\u00e1ng histamin n\u1ebfu n\u1eb7ng v\u1eeba; m\u1edf th\u00f4ng \u0111\u01b0\u1eddng th\u1edf, noradrenalin, theo d\u00f5i tim, truy\u1ec1n d\u1ecbch.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"48-tuong-tac-voi-cac-thuoc-khac\"><\/span>4.8 T\u01b0\u01a1ng t\u00e1c v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Kh\u00f4ng c\u00f3 nghi\u00ean c\u1ee9u t\u01b0\u01a1ng t\u00e1c thu\u1ed1c ch\u00ednh th\u1ee9c n\u00e0o \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n. Theo c\u00e1c t\u00e0i li\u1ec7u \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 c\u1ee7a thu\u1ed1c trastuzumab kh\u00e1c, hi\u1ec7n v\u1eabn ch\u01b0a quan s\u00e1t th\u1ea5y t\u01b0\u01a1ng t\u00e1c c\u00f3 \u00fd ngh\u0129a l\u00e2m s\u00e0ng v\u1edbi c\u00e1c thu\u1ed1c d\u00f9ng \u0111\u1ed3ng th\u1eddi trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"49-qua-lieu-va-xu-tri\"><\/span>4.9 Qu\u00e1 li\u1ec1u v\u00e0 x\u1eed tr\u00ed:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Theo c\u00e1c t\u00e0i li\u1ec7u \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1, hi\u1ec7n v\u1eabn ch\u01b0a c\u00f3 kinh nghi\u1ec7m v\u1ec1 qu\u00e1 li\u1ec1u c\u1ee7a thu\u1ed1c n\u00e0y trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng \u1edf ng\u01b0\u1eddi.<\/p>\n<p>Theo t\u00e0i li\u1ec7u \u0111\u00e3 c\u00f4ng b\u1ed1 c\u1ee7a thu\u1ed1c trastuzumab kh\u00e1c, li\u1ec1u duy nh\u1ea5t trastuzumab \u0111\u01a1n tr\u1ecb &gt;10 mg\/kg ch\u01b0a \u0111\u01b0\u1ee3c th\u1ef1c hi\u1ec7n trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng. Nh\u1eefng li\u1ec1u &lt; 10 mg\/kg \u0111\u01b0\u1ee3c dung n\u1ea1p t\u1ed1t.<\/p>\n<h1><span class=\"ez-toc-section\" id=\"5-co-che-tac-dung-cua-thuoc\"><\/span>5. C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng c\u1ee7a thu\u1ed1c :<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<h2><span class=\"ez-toc-section\" id=\"51-duoc-luc-hoc\"><\/span>5.1. D\u01b0\u1ee3c l\u1ef1c h\u1ecdc:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Nh\u00f3m d\u01b0\u1ee3c l\u00fd: thu\u1ed1c kh\u00e1ng ung th\u01b0, kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng, m\u00e3 ATC: L01XC03<\/p>\n<p>Trastuzumab l\u00e0 kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng t\u00e1i t\u1ed5 h\u1ee3p DNA c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb ng\u01b0\u1eddi, t\u00e1c \u0111\u1ed9ng ch\u1ecdn l\u1ecdc l\u00ean th\u00e0nh ph\u1ea7n ngo\u1ea1i b\u00e0o c\u1ee7a protein th\u1ee5 th\u1ec3 2 c\u1ee7a y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng bi\u1ec3u b\u00ec ng\u01b0\u1eddi (HER2). Ti\u1ec1n gen sinh ung HER2 ho\u1eb7c c-erbB2 m\u00e3 h\u00f3a cho m\u1ed9t protein gi\u1ed1ng th\u1ee5 th\u1ec3, xuy\u00ean m\u00e0ng t\u1ebf b\u00e0o, c\u00f3 tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed l\u00e0 185kDa, v\u00e0 c\u00f3 li\u00ean quan v\u1ec1 m\u1eb7t c\u1ea5u tr\u00fac v\u1edbi th\u1ee5 th\u1ec3 y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng bi\u1ec3u b\u00ec. S\u1ef1 b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c c\u1ee7a HER2 \u0111\u01b0\u1ee3c ghi nh\u1eadn trong 25-30% tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 v\u00fa nguy\u00ean ph\u00e1t v\u00e0 6,8% &#8211; 42,6% ung th\u01b0 d\u1ea1 d\u00e0y ti\u1ebfn tri\u1ec3n. H\u1eadu qu\u1ea3 c\u1ee7a vi\u1ec7c khu\u1ebfch \u0111\u1ea1i gen HER2 l\u00e0 gia t\u0103ng b\u1ed9c l\u1ed9 protein HER2 tr\u00ean b\u1ec1 m\u1eb7t nh\u1eefng t\u1ebf b\u00e0o kh\u1ed1i u n\u00e0y, d\u1eabn \u0111\u1ebfn vi\u1ec7c ho\u1ea1t h\u00f3a th\u1ee5 th\u1ec3 HER2.<\/p>\n<p>C\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 cho th\u1ea5y nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nh\u1eefng kh\u1ed1i u c\u00f3 s\u1ef1 khu\u1ebfch \u0111\u1ea1i hay b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c HER2 c\u00f3 th\u1eddi gian s\u1ed1ng kh\u00f4ng b\u1ec7nh ng\u1eafn h\u01a1n so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 s\u1ef1 khu\u1ebfch \u0111\u1ea1i hay b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c c\u1ee7a HER2.<\/p>\n<p>Trong nh\u1eefng th\u1eed nghi\u1ec7m in-vitro v\u00e0 tr\u00ean \u0111\u1ed9ng v\u1eadt, trastuzumab cho th\u1ea5y kh\u1ea3 n\u0103ng \u1ee9c ch\u1ebf s\u1ef1 t\u0103ng sinh c\u00e1c t\u1ebf b\u00e0o kh\u1ed1i u ng\u01b0\u1eddi c\u00f3 b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c HER2. Nghi\u00ean c\u1ee9u in vitro cho th\u1ea5y t\u00e1c d\u1ee5ng g\u00e2y \u0111\u1ed9c t\u1ebf b\u00e0o qua trung gian t\u1ebf b\u00e0o ph\u1ee5 thu\u1ed9c kh\u00e1ng th\u1ec3 (ADCC) c\u1ee7a trastuzumab t\u00e1c \u0111\u1ed9ng \u01b0u ti\u00ean tr\u00ean nh\u1eefng t\u1ebf b\u00e0o ung th\u01b0 c\u00f3 b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c HER2 so v\u1edbi nh\u1eefng t\u1ebf b\u00e0o ung th\u01b0 kh\u00f4ng c\u00f3 s\u1ef1 b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c HER2.<\/p>\n<p><em>C\u00e1c nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng\/Hi\u1ec7u qu\u1ea3<\/em><\/p>\n<p><em>Ung th\u01b0 v\u00fa<\/em><\/p>\n<p>Ung th\u01b0 v\u00fa di c\u0103n<\/p>\n<p>Trastuzumab \u0111\u01a1n tr\u1ecb \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong c\u00e1c th\u1eed nghi\u1ec7m l\u00e2m s\u00e0ng cho nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb ung th\u01b0 v\u00fa di c\u0103n, c\u00f3 kh\u1ed1i u c\u00f3 s\u1ef1 b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c HER2 v\u00e0 \u0111\u00e3 th\u1ea5t b\u1ea1i v\u1edbi m\u1ed9t hay nhi\u1ec1u ph\u00e1c \u0111\u1ed3 h\u00f3a tr\u1ecb kh\u00e1c cho b\u1ec7nh di c\u0103n c\u1ee7a h\u1ecd.<\/p>\n<p>Trastuzumab c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong nh\u1eefng nghi\u00ean c\u1ee9u l\u00e2m s\u00e0ng k\u1ebft h\u1ee3p v\u1edbi paclitaxel ho\u1eb7c v\u1edbi m\u1ed9t anthracycline (doxorubicin ho\u1eb7c epirubicin) c\u00f9ng v\u1edbi cyclophosphamide (AC) \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u01b0\u1edbc m\u1ed9t cho nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb ung th\u01b0 v\u00fa di c\u0103n v\u1edbi kh\u1ed1i u c\u00f3 s\u1ef1 b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c HER2. Nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc \u0111\u00f3 b\u1eb1ng h\u00f3a tr\u1ecb c\u00f3 k\u1ebft h\u1ee3p anthracycline \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi paclitaxel (175mg\/m2 truy\u1ec1n trong 3 gi\u1edd) c\u00f3 ho\u1eb7c kh\u00f4ng c\u00f3 trastuzumab. B\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi trastuzumab cho \u0111\u1ebfn khi b\u1ec7nh ti\u1ebfn tri\u1ec3n.<\/p>\n<p>Trastuzumab \u0111\u01a1n tr\u1ecb, khi s\u1eed d\u1ee5ng \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u01b0\u1edbc hai ho\u1eb7c b\u01b0\u1edbc ba cho nh\u1eefng ph\u1ee5 n\u1eef b\u1ecb ung th\u01b0 v\u00fa di c\u0103n c\u00f3 s\u1ef1 b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c HER2 cho t\u1ec9 l\u1ec7 \u0111\u00e1p \u1ee9ng kh\u1ed1i u to\u00e0n b\u1ed9 l\u00e0 15% v\u00e0 th\u1eddi gian s\u1ed1ng trung b\u00ecnh l\u00e0 13 th\u00e1ng.<\/p>\n<p>S\u1eed d\u1ee5ng trastuzumab k\u1ebft h\u1ee3p v\u1edbi paclitaxel \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u01b0\u1edbc m\u1ed9t cho nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb ung th\u01b0 v\u00fa di c\u0103n c\u00f3 b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c HER2 k\u00e9o d\u00e0i \u0111\u00e1ng k\u1ec3 trung b\u00ecnh th\u1eddi gian \u0111\u1ebfn khi b\u1ec7nh ti\u1ebfn tri\u1ec3n so v\u1edbi b\u1ec7nh nh\u00e2n ch\u1ec9 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng paclitaxel. S\u1ef1 gia t\u0103ng trung b\u00ecnh th\u1eddi gian \u0111\u1ebfn khi b\u1ec7nh ti\u1ebfn tri\u1ec3n \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng paclitaxel l\u00e0 3,9 th\u00e1ng (6,9 th\u00e1ng so v\u1edbi 3,0 th\u00e1ng). \u0110\u00e1p \u1ee9ng c\u1ee7a kh\u1ed1i u v\u00e0 t\u1ef7 l\u1ec7 s\u1ed1ng m\u1ed9t n\u0103m c\u0169ng t\u0103ng khi \u0111i\u1ec1u tr\u1ecb trastuzumab k\u1ebft h\u1ee3p v\u1edbi paclitaxel so v\u1edbi paclitaxel \u0111\u01a1n tr\u1ecb.<\/p>\n<p>Trastuzumab c\u0169ng \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u trong m\u1ed9t th\u1eed nghi\u1ec7m ng\u1eabu nhi\u00ean, c\u00f3 \u0111\u1ed1i ch\u1ee9ng, ph\u1ed1i h\u1ee3p v\u1edbi docetaxel, \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u01b0\u1edbc m\u1ed9t cho nh\u1eefng ph\u1ee5 n\u1eef b\u1ecb ung th\u01b0 v\u00fa di c\u0103n. Ph\u1ed1i h\u1ee3p trastuzumab v\u00e0 docetaxel l\u00e0m t\u0103ng \u0111\u00e1ng k\u1ec3 t\u1ec9 l\u1ec7 \u0111\u00e1p \u1ee9ng (61% so v\u1edbi 34%) v\u00e0 k\u00e9o d\u00e0i trung b\u00ecnh th\u1eddi gian \u0111\u1ebfn khi b\u1ec7nh ti\u1ebfn tri\u1ec3n (th\u00eam kho\u1ea3ng 5,6 th\u00e1ng) so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n ch\u1ec9 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi docetaxel. Th\u1eddi gian s\u1ed1ng trung b\u00ecnh c\u0169ng t\u0103ng \u0111\u00e1ng k\u1ec3 \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p, so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n ch\u1ec9 \u0111i\u1ec1u tr\u1ecb v\u1edbi docetaxel (31,2 th\u00e1ng so v\u1edbi 22,7 th\u00e1ng).<\/p>\n<p><em>\u0110i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p trastuzumab v\u1edbi anastrozole<\/em><\/p>\n<p>Trastuzumab \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u d\u00f9ng ph\u1ed1i h\u1ee3p v\u1edbi anastrozole \u0111\u1ec3 \u0111i\u1ec1u tr\u1ecb b\u01b0\u1edbc m\u1ed9t cho nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb ung th\u01b0 v\u00fa di c\u0103n c\u00f3 b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c HER2 v\u00e0 d\u01b0\u01a1ng t\u00ednh v\u1edbi th\u1ee5 th\u1ec3 hormone (v\u00ed d\u1ee5 th\u1ee5 th\u1ec3 estrogen [EM] v\u00e0\/ho\u1eb7c th\u1ee5 th\u1ec3 progesterone [PR]). Th\u1eddi gian s\u1ed1ng kh\u00f4ng c\u00f3 ti\u1ebfn tri\u1ec3n b\u1ec7nh k\u00e9o d\u00e0i g\u1ea5p \u0111\u00f4i \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb v\u1edbi trastuzumab k\u1ebft h\u1ee3p anastrozole, so v\u1edbi nh\u00f3m ch\u1ec9 d\u00f9ng anastrozole (4,8 th\u00e1ng so v\u1edbi 2,4 th\u00e1ng). \u0110\u1ed1i v\u1edbi nh\u1eefng th\u00f4ng s\u1ed1 kh\u00e1c, t\u00ecnh tr\u1ea1ng c\u1ea3i thi\u1ec7n c\u0169ng \u0111\u00e3 \u0111\u01b0\u1ee3c ghi nh\u1eadn \u1edf nh\u00f3m \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p nh\u01b0: \u0111\u00e1p \u1ee9ng to\u00e0n b\u1ed9 (16,5% so v\u1edbi 6,7%), t\u1ef7 l\u1ec7 \u0111\u1ea1t hi\u1ec7u qu\u1ea3 tr\u00ean l\u00e2m s\u00e0ng (42,7% so v\u1edbi 27,9%), th\u1eddi gian cho \u0111\u1ebfn khi b\u1ec7nh ti\u1ebfn tri\u1ec3n (4,8 th\u00e1ng so v\u1edbi 2,4 th\u00e1ng). Kh\u00f4ng c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0o \u0111\u01b0\u1ee3c ghi nh\u1eadn gi\u1eefa hai nh\u00f3m v\u1ec1 th\u1eddi gian \u0111\u00e1p \u1ee9ng v\u00e0 kho\u1ea3ng th\u1eddi gian c\u00f3 \u0111\u00e1p \u1ee9ng. Trung b\u00ecnh th\u1eddi gian s\u1ed1ng to\u00e0n b\u1ed9 \u0111\u00e3 \u0111\u01b0\u1ee3c k\u00e9o d\u00e0i \u0111\u1ebfn 4,6 th\u00e1ng \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n trong nh\u00f3m \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p. S\u1ef1 kh\u00e1c bi\u1ec7t n\u00e0y kh\u00f4ng c\u00f3 \u00fd ngh\u0129a v\u1ec1 m\u1eb7t th\u1ed1ng k\u00ea, tuy nhi\u00ean, h\u01a1n m\u1ed9t n\u1eeda s\u1ed1 b\u1ec7nh nh\u00e2n trong nh\u00f3m d\u00f9ng anastrozole \u0111\u01a1n tr\u1ecb \u0111\u00e3 chuy\u1ec3n sang d\u00f9ng ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb c\u00f3 s\u1eed d\u1ee5ng trastuzumab sau khi b\u1ec7nh ti\u1ebfn tri\u1ec3n. 52% s\u1ed1 b\u1ec7nh nh\u00e2n d\u00f9ng trastuzumab k\u1ebft h\u1ee3p v\u1edbi anastrozole \u0111\u00e3 s\u1ed1ng \u0111\u01b0\u1ee3c \u00edt nh\u1ea5t 2 n\u0103m trong khi t\u1ef7 l\u1ec7 n\u00e0y \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n ch\u1ec9 d\u00f9ng anastrozole l\u00e0 45%.<\/p>\n<p><em>Ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm<\/em><\/p>\n<p>Trong tr\u01b0\u1eddng h\u1ee3p n\u00e0y, trastuzumab \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u trong th\u1eed nghi\u1ec7m \u0111a trung t\u00e2m, ng\u1eabu nhi\u00ean (HERA) nh\u1eb1m so s\u00e1nh vi\u1ec7c \u0111i\u1ec1u tr\u1ecb trastuzumab m\u1ed7i ba tu\u1ea7n trong m\u1ed9t n\u0103m v\u1edbi nh\u00f3m ch\u1ee9ng tr\u00ean b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm c\u00f3 HER2 d\u01b0\u01a1ng t\u00ednh sau ph\u1eabu thu\u1eadt, \u0111\u00e3 d\u00f9ng ho\u00e1 tr\u1ecb v\u00e0 x\u1ea1 tr\u1ecb (n\u1ebfu c\u00f3). B\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c d\u00f9ng li\u1ec1u t\u1ea3i kh\u1edfi \u0111\u1ea7u l\u00e0 8mg\/kg, sau \u0111\u00f3 l\u00e0 6mg\/kg m\u1ed7i ba tu\u1ea7n trong m\u1ed9t n\u0103m.<\/p>\n<p>Hi\u1ec7u qu\u1ea3 t\u1eeb th\u1eed nghi\u1ec7m HERA \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong b\u1ea3ng sau:<\/p>\n<p>B\u1ea3ng 1: Hi\u1ec7u qu\u1ea3 sau m\u1ed9t n\u0103m t\u1eeb th\u1eed nghi\u1ec7m HERA.<\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>Th\u00f4ng s\u1ed1<\/strong><\/td>\n<td><strong>Nh\u00f3m ch\u1ee9ng N=1693<\/strong><\/td>\n<td><strong>\u0110i\u1ec1u tr\u1ecb b\u1eb1ng trastuzumab trong m\u1ed9t n\u0103m N = 1693 <\/strong><\/td>\n<td><strong>Gi\u00e1 tr\u1ecb p so v\u1edbi nh\u00f3m ch\u1ee9ng<\/strong><\/td>\n<td><strong>T\u1ec9 l\u1ec7 nguy c\u01a1 so v\u1edbi nh\u00f3m ch\u1ee9ng<\/strong><\/td>\n<\/tr>\n<tr>\n<td>S\u1ed1ng kh\u00f4ng b\u1ec7nh<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>&#8211; S\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 s\u1ef1 ki\u1ec7n n\u00e0y<\/td>\n<td>219(12.9%)<\/td>\n<td>127 (7.5%)<\/td>\n<td>&lt;0.0001<\/td>\n<td>0.54<\/td>\n<\/tr>\n<tr>\n<td>&#8211; S\u1ed1 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 s\u1ef1 ki\u1ec7n n\u00e0y<\/td>\n<td>1474 (87.1%)<\/td>\n<td>1566 (92.5%)<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>S\u1ed1ng m\u00e0 b\u1ec7nh kh\u00f4ng t\u00e1i ph\u00e1t<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>&#8211; S\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 s\u1ef1 ki\u1ec7n n\u00e0y<\/td>\n<td>208 (12.3%)<\/td>\n<td>113(6.7%)<\/td>\n<td>&lt;0.0001<\/td>\n<td>0.51<\/td>\n<\/tr>\n<tr>\n<td>&#8211; S\u1ed1 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 s\u1ef1 ki\u1ec7n n\u00e0y<\/td>\n<td>1485 (87.7%)<\/td>\n<td>1580 (93.3%)<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>S\u1ed1ng m\u00e0 b\u1ec7nh kh\u00f4ng t\u00e1i ph\u00e1t xa<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>&#8211; S\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 s\u1ef1 ki\u1ec7n n\u00e0y<\/td>\n<td>184(10.9%)<\/td>\n<td>99 (5.8%)<\/td>\n<td>&lt;0.0001<\/td>\n<td>0.5<\/td>\n<\/tr>\n<tr>\n<td>&#8211; S\u1ed1 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 s\u1ef1 ki\u1ec7n n\u00e0y<\/td>\n<td>1508 (89.1%)<\/td>\n<td>1594 (94.6%)<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>T\u1ec9 l\u1ec7 s\u1ed1ng n\u00f3i chung (t\u1eed vong)<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<tr>\n<td>&#8211; S\u1ed1 b\u1ec7nh nh\u00e2n c\u00f3 s\u1ef1 ki\u1ec7n n\u00e0y<\/td>\n<td>40 (2.4%)<\/td>\n<td>31 (1.8%)<\/td>\n<td>0.24<\/td>\n<td>0.75<\/td>\n<\/tr>\n<tr>\n<td>&#8211; S\u1ed1 b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 s\u1ef1 ki\u1ec7n n\u00e0y<\/td>\n<td>1653 (97.65)<\/td>\n<td>1662 (98.2%)<\/td>\n<td>&nbsp;<\/td>\n<td>&nbsp;<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>V\u1edbi k\u1ebft qu\u1ea3 cho t\u1ec9 l\u1ec7 s\u1ed1ng kh\u00f4ng b\u1ec7nh (DFS) ban \u0111\u1ea7u, t\u1ec9 l\u1ec7 nguy c\u01a1 tr\u1edf th\u00e0nh l\u1ee3i \u00edch tuy\u1ec7t \u0111\u1ed1i, v\u1edbi t\u1ec9 l\u1ec7 s\u1ed1ng kh\u00f4ng b\u1ec7nh trong v\u00f2ng hai n\u0103m t\u0103ng 7,6% (85,8% so v\u1edbi 78,2%) trong nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng trastuzumab.<\/p>\n<p><em>Ung th\u01b0 d\u1ea1 d\u00e0y ti\u1ebfn tri\u1ec3n<\/em><\/p>\n<p>C\u00e1c k\u1ebft qu\u1ea3 v\u1ec1 hi\u1ec7u qu\u1ea3 t\u1eeb th\u1eed nghi\u1ec7m ToGA \u0111\u01b0\u1ee3c t\u00f3m t\u1eaft trong b\u1ea3ng 5. Nh\u1eefng b\u1ec7nh nh\u00e2n tham gia v\u00e0o th\u1eed nghi\u1ec7m n\u00e0y l\u00e0 nh\u1eefng b\u1ec7nh nh\u00e2n ch\u01b0a \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb tr\u01b0\u1edbc \u0111\u00f3 v\u1edbi ung th\u01b0 d\u1ea1 d\u00e0y ho\u1eb7c ung th\u01b0 mi\u1ec7ng n\u1ed1i d\u1ea1 d\u00e0y th\u1ef1c qu\u1ea3n ti\u1ebfn tri\u1ec3n t\u1ea1i ch\u1ed7 ho\u1eb7c t\u00e1i ph\u00e1t v\u00e0\/ho\u1eb7c di c\u0103n c\u00f3 HER2 d\u01b0\u01a1ng t\u00ednh, kh\u00f4ng th\u1ec3 ch\u1eefa kh\u1ecfi b\u1ec7nh. Th\u1eddi gian s\u1ed1ng to\u00e0n b\u1ed9 \u0111\u01b0\u1ee3c \u0111\u1ecbnh ngh\u0129a l\u00e0 th\u1eddi gian k\u1ec3 t\u1eeb ng\u00e0y ph\u00e2n ph\u1ed1i ng\u1eabu nhi\u00ean cho t\u1edbi ng\u00e0y t\u1eed vong v\u00ec b\u1ea5t c\u1ee9 nguy\u00ean nh\u00e2n g\u00ec. \u1ede th\u1eddi \u0111i\u1ec3m ph\u00e2n t\u00edch, t\u1ed5ng s\u1ed1 349 b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ph\u00e2n ph\u1ed1i ng\u1eabu nhi\u00ean \u0111\u00e3 ch\u1ebft: 182 b\u1ec7nh nh\u00e2n (62,8%) trong nh\u00f3m ch\u1ee9ng v\u00e0 167 b\u1ec7nh nh\u00e2n (56,8%) trong nh\u00f3m \u0111i\u1ec1u tr\u1ecb (4). \u0110a s\u1ed1 t\u1eed vong \u0111\u1ec1u do c\u00e1c bi\u1ebfn c\u1ed1 li\u00ean quan t\u1edbi ung th\u01b0 ti\u1ec1m \u1ea9n. Th\u1eddi gian s\u1ed1ng to\u00e0n b\u1ed9 \u0111\u01b0\u1ee3c c\u1ea3i thi\u1ec7n m\u1ed9t c\u00e1ch c\u00f3 \u00fd ngh\u0129a \u1edf nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng trastuzumab + capecitabine\/5-FU v\u00e0 cisplatin so v\u1edbi nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng capecitabine\/5-FU v\u00e0 cisplatin (p = 0,0046, theo ki\u1ec3m \u0111\u1ecbnh Log-Rank). Th\u1eddi gian s\u1ed1ng trung b\u00ecnh l\u00e0 11,1 th\u00e1ng \u1edf nh\u00f3m capecitabine\/5-FU v\u00e0 cisplatin so v\u1edbi 13,8 th\u00e1ng \u1edf nh\u00f3m trastuzumab + capecitabine\/5-FU v\u00e0 cisplatin. Nguy c\u01a1 t\u1eed vong gi\u1ea3m 26% (T\u1ef7 s\u1ed1 r\u1ee7i ro [HR] 0,74 95% CI [0,60 &#8211; 0,91]) \u1edf nh\u00f3m b\u1ec7nh nh\u00e2n d\u00f9ng trastuzumab so v\u1edbi nh\u00f3m b\u1ec7nh nh\u00e2n d\u00f9ng capecitabine\/5-FU (4).<\/p>\n<p>C\u00e1c ph\u00e2n t\u00edch ph\u00e2n nh\u00f3m post-hoc \u0111\u00e3 ch\u1ec9 ra r\u1eb1ng c\u00e1c kh\u1ed1i u \u0111\u00edch c\u00f3 m\u1ee9c protein HER2 cao h\u01a1n (IHC 2+\/FISH+ v\u00e0 IHC 3+\/kh\u00f4ng t\u00ednh \u0111\u1ebfn tr\u1ea1ng th\u00e1i c\u1ee7a FISH) c\u00f3 hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb t\u1ed1t h\u01a1n. Trung b\u00ecnh th\u1eddi gian s\u1ed1ng to\u00e0n b\u1ed9 trong nh\u00f3m c\u00f3 HER2 cao l\u00e0 11,8 th\u00e1ng v\u00e0 16 th\u00e1ng, HR 0,65 (95% CI 0,51 &#8211; 0,83) trung b\u00ecnh th\u1eddi gian s\u1ed1ng b\u1ec7nh kh\u00f4ng ti\u1ebfn tri\u1ec3n l\u00e0 5,5 th\u00e1ng v\u00e0 7,6 th\u00e1ng, HR 0,64 (95% CI 0,51 &#8211; 0,79) t\u01b0\u01a1ng \u1ee9ng v\u1edbi nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng capecitabine\/5FU + cisplatin v\u00e0 nh\u00f3m \u0111i\u1ec1u tr\u1ecb b\u1eb1ng trastuzumab + capecitabine\/5FU v\u00e0 cisplatin.<\/p>\n<p>B\u1ea3ng 2: T\u00f3m t\u1eaft hi\u1ec7u qu\u1ea3 t\u1eeb nghi\u00ean c\u1ee9u B018255<\/p>\n<table>\n<tbody>\n<tr>\n<td><strong>Th\u00f4ng s\u1ed1<\/strong><\/td>\n<td><strong>FP <\/strong><\/p>\n<p><strong>N = 290<\/strong><\/td>\n<td><strong>FP+H <\/strong><\/p>\n<p><strong>N = 294<\/strong><\/td>\n<td><strong>HR <\/strong><\/p>\n<p><strong>(95% CI)<\/strong><\/td>\n<td><strong>Gi\u00e1 tr\u1ecb p<\/strong><\/td>\n<\/tr>\n<tr>\n<td>Th\u1eddi gian s\u1ed1ng to\u00e0n b\u1ed9, s\u1ed1 th\u00e1ng trung b\u00ecnh<\/td>\n<td>11.1<\/td>\n<td>13.8<\/td>\n<td>0.74<\/p>\n<p>(0.60-0.91)<\/td>\n<td>0.0046<\/td>\n<\/tr>\n<tr>\n<td>Th\u1eddi gian s\u1ed1ng b\u1ec7nh kh\u00f4ng ti\u1ebfn tri\u1ec3n, s\u1ed1 th\u00e1ng trung b\u00ecnh<\/td>\n<td>5.5<\/td>\n<td>6.7<\/td>\n<td>0.71<\/p>\n<p>(0.59-0.85)<\/td>\n<td>0.0002<\/td>\n<\/tr>\n<tr>\n<td>Th\u1eddi gian cho t\u1edbi khi b\u1ec7nh ti\u1ebfn tri\u1ec3n, s\u1ed1 th\u00e1ng trung b\u00ecnh<\/td>\n<td>5.6<\/td>\n<td>7.1<\/td>\n<td>0.7<\/p>\n<p>(0.58-0.85)<\/td>\n<td>0.0003<\/td>\n<\/tr>\n<tr>\n<td>T\u1ec9 l\u1ec7 \u0111\u00e1p \u1ee9ng to\u00e0n b\u1ed9, %<\/td>\n<td>34.50%<\/td>\n<td>47.30%<\/td>\n<td>1.70<sup>a<\/sup> (1.22, 2.38)<\/td>\n<td>0.0017<\/td>\n<\/tr>\n<tr>\n<td>Kho\u1ea3ng th\u1eddi gian c\u00f3 \u0111\u00e1p \u1ee9ng, s\u1ed1 th\u00e1ng trung b\u00ecnh<\/td>\n<td>4.8<\/td>\n<td>6.9<\/td>\n<td>0.54<\/p>\n<p>(0.40-0.73)<\/td>\n<td>0.0001<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>FP: Fluoropyrimidine\/cisplatin<\/p>\n<p>FP+H: Fluoropyrimidine\/cisplatin + trastuzumab<\/p>\n<p>a: T\u1ef7 s\u1ed1 ch\u00eanh<\/p>\n<p><em>T\u00ednh sinh mi\u1ec5n d\u1ecbch<\/em><\/p>\n<p>Kh\u00e1ng th\u1ec3 ch\u1ed1ng trastuzumab \u1edf ng\u01b0\u1eddi \u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n \u1edf m\u1ed9t b\u1ec7nh nh\u00e2n trong s\u1ed1 903 b\u1ec7nh nh\u00e2n v\u00e0 ng\u01b0\u1eddi n\u00e0y kh\u00f4ng c\u00f3 c\u00e1c bi\u1ec3u hi\u1ec7n d\u1ecb \u1ee9ng.<\/p>\n<p><strong><em>C\u01a1 ch\u1ebf t\u00e1c d\u1ee5ng: <\/em><\/strong><\/p>\n<p>Trastuzumab l\u00e0 kh\u00e1ng th\u1ec3 \u0111\u01a1n d\u00f2ng t\u00e1i t\u1ed5 h\u1ee3p DNA c\u00f3 ngu\u1ed3n g\u1ed1c t\u1eeb ng\u01b0\u1eddi, t\u00e1c \u0111\u1ed9ng ch\u1ecdn l\u1ecdc l\u00ean th\u00e0nh ph\u1ea7n ngo\u1ea1i b\u00e0o c\u1ee7a protein th\u1ee5 th\u1ec3 2 c\u1ee7a y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng bi\u1ec3u b\u00ec ng\u01b0\u1eddi (HER2). Kh\u00e1ng th\u1ec3 n\u00e0y l\u00e0 m\u1ed9t IgG1 c\u00f3 nh\u1eefng ph\u00e2n v\u00f9ng khung t\u1eeb ng\u01b0\u1eddi v\u00e0 nh\u1eefng ph\u00e2n v\u00f9ng x\u00e1c \u0111\u1ecbnh t\u00ednh b\u1ed5 sung c\u1ee7a kh\u00e1ng th\u1ec3 t\u1eeb chu\u1ed9t ch\u1ed1ng p185 HER2 g\u1eafn v\u1edbi HER2.<\/p>\n<p>Ti\u1ec1n gen sinh ung HER2 ho\u1eb7c c-erbB2 m\u00e3 h\u00f3a cho m\u1ed9t protein gi\u1ed1ng th\u1ee5 th\u1ec3, xuy\u00ean m\u00e0ng t\u1ebf b\u00e0o, c\u00f3 tr\u1ecdng l\u01b0\u1ee3ng ph\u00e2n t\u1eed l\u00e0 185kDa, v\u00e0 c\u00f3 li\u00ean quan v\u1ec1 m\u1eb7t c\u1ea5u tr\u00fac v\u1edbi th\u1ee5 th\u1ec3 y\u1ebfu t\u1ed1 t\u0103ng tr\u01b0\u1edfng bi\u1ec3u b\u00ec. S\u1ef1 b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c c\u1ee7a HER2 \u0111\u01b0\u1ee3c ghi nh\u1eadn trong 25-30% tr\u01b0\u1eddng h\u1ee3p ung th\u01b0 v\u00fa nguy\u00ean ph\u00e1t v\u00e0 6,8% &#8211; 42,6% ung th\u01b0 d\u1ea1 d\u00e0y ti\u1ebfn tri\u1ec3n. H\u1eadu qu\u1ea3 c\u1ee7a vi\u1ec7c khu\u1ebfch \u0111\u1ea1i gen HER2 l\u00e0 gia t\u0103ng b\u1ed9c l\u1ed9 protein HER2 tr\u00ean b\u1ec1 m\u1eb7t nh\u1eefng t\u1ebf b\u00e0o kh\u1ed1i u n\u00e0y, d\u1eabn \u0111\u1ebfn vi\u1ec7c ho\u1ea1t h\u00f3a th\u1ee5 th\u1ec3 HER2.<\/p>\n<p>C\u00e1c nghi\u00ean c\u1ee9u \u0111\u00e3 cho th\u1ea5y nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 nh\u1eefng kh\u1ed1i u c\u00f3 s\u1ef1 khu\u1ebfch \u0111\u1ea1i hay b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c HER2 c\u00f3 th\u1eddi gian s\u1ed1ng kh\u00f4ng b\u1ec7nh ng\u1eafn h\u01a1n so v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 s\u1ef1 khu\u1ebfch \u0111\u1ea1i hay b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c c\u1ee7a HER2.<\/p>\n<p>Trong nh\u1eefng th\u1eed nghi\u1ec7m in-vitro v\u00e0 tr\u00ean \u0111\u1ed9ng v\u1eadt, trastuzumab cho th\u1ea5y kh\u1ea3 n\u0103ng \u1ee9c ch\u1ebf s\u1ef1 t\u0103ng sinh c\u00e1c t\u1ebf b\u00e0o kh\u1ed1i u ng\u01b0\u1eddi c\u00f3 b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c HER2. Nghi\u00ean c\u1ee9u in vitro cho th\u1ea5y t\u00e1c d\u1ee5ng g\u00e2y \u0111\u1ed9c t\u1ebf b\u00e0o qua trung gian t\u1ebf b\u00e0o ph\u1ee5 thu\u1ed9c kh\u00e1ng th\u1ec3 (ADCC) c\u1ee7a trastuzumab t\u00e1c \u0111\u1ed9ng \u01b0u ti\u00ean tr\u00ean nh\u1eefng t\u1ebf b\u00e0o ung th\u01b0 c\u00f3 b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c HER2 so v\u1edbi nh\u1eefng t\u1ebf b\u00e0o ung th\u01b0 kh\u00f4ng c\u00f3 s\u1ef1 b\u1ed9c l\u1ed9 qu\u00e1 m\u1ee9c HER2.<\/p>\n<p><strong>[XEM T\u1ea0I \u0110\u00c2Y]<\/strong><\/p>\n<h2><span class=\"ez-toc-section\" id=\"52-duoc-dong-hoc\"><\/span>5.2. D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a trastuzumab \u0111\u00e3 \u0111\u01b0\u1ee3c nghi\u00ean c\u1ee9u tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb ung th\u01b0 v\u00fa c\u00f3 di c\u0103n, ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm. Trong c\u00e1c nghi\u00ean c\u1ee9u \u1edf Pha I, truy\u1ec1n t\u0129nh m\u1ea1ch nhanh 10, 50, 100, 250 v\u00e0 500 mg trastuzumab m\u1ed7i tu\u1ea7n m\u1ed9t l\u1ea7n tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n n\u00e0y cho th\u1ea5y t\u00ednh ch\u1ea5t d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc ph\u1ee5 thu\u1ed9c v\u00e0o li\u1ec1u. Th\u1eddi gian b\u00e1n th\u1ea3i trung b\u00ecnh t\u0103ng v\u00e0 \u0111\u1ed9 thanh th\u1ea3i gi\u1ea3m khi t\u0103ng li\u1ec1u.<\/p>\n<p><em>Ung th\u01b0 v\u00fa<\/em><\/p>\n<p><em>D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh trong ung th\u01b0 v\u00fa<\/em><\/p>\n<p>Ph\u01b0\u01a1ng ph\u00e1p d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc tr\u00ean d\u00e2n s\u1ed1 s\u1eed d\u1ee5ng s\u1ed1 li\u1ec7u t\u1eeb c\u00e1c nghi\u00ean c\u1ee9u Pha I, Pha II, v\u00e0 nghi\u00ean c\u1ee9u then ch\u1ed1t Pha III, \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa di c\u0103n d\u00f9ng trastuzumab v\u1edbi li\u1ec1u t\u1ea3i 4 mg\/kg, sau \u0111\u00f3 d\u00f9ng li\u1ec1u duy tr\u00ec h\u00e0ng tu\u1ea7n l\u00e0 2 mg\/kg. Theo ph\u01b0\u01a1ng ph\u00e1p n\u00e0y, \u0111\u1ed9 thanh th\u1ea3i \u0111i\u1ec3n h\u00ecnh c\u1ee7a trastuzumab l\u00e0 0,225 L\/ng\u00e0y v\u00e0 th\u1ec3 t\u00edch ph\u00e2n b\u1ed1 thu\u1ed1c \u0111i\u1ec3n h\u00ecnh l\u00e0 2,95 L v\u1edbi th\u1eddi gian b\u00e1n th\u1ea3i cu\u1ed1i c\u00f9ng t\u01b0\u01a1ng \u1ee9ng l\u00e0 28,5 ng\u00e0y (kho\u1ea3ng tin c\u1eady 95%: 25,5-32,8 ng\u00e0y). V\u00f9ng d\u01b0\u1edbi \u0111\u01b0\u1eddng cong bi\u1ec3u th\u1ecb n\u1ed3ng \u0111\u1ed9 thu\u1ed1c theo th\u1eddi gian AUC h\u00e0ng tu\u1ea7n \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh l\u00e0 578 mg\u00b7ng\u00e0y\/L, n\u1ed3ng \u0111\u1ed9 \u0111\u1ec9nh l\u00e0 110 mg\/L v\u00e0 n\u1ed3ng \u0111\u1ed9 \u0111\u00e1y l\u00e0 66 mg\/L c\u00f3 th\u1ec3 \u0111\u1ea1t \u0111\u01b0\u1ee3c trong v\u00f2ng 143 ng\u00e0y ho\u1eb7c kho\u1ea3ng 20 tu\u1ea7n. Sau khi ng\u1eebng \u0111i\u1ec1u tr\u1ecb trastuzumab, ng\u01b0\u1eddi ta c\u0169ng d\u1ef1 t\u00ednh ph\u1ea3i m\u1ea5t m\u1ed9t kho\u1ea3ng th\u1eddi gian t\u01b0\u01a1ng t\u1ef1 \u0111\u1ec3 th\u1ea3i h\u1ebft trastuzumab.<\/p>\n<p>\u0110\u00e1nh gi\u00e1 tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n ung th\u01b0 v\u00fa giai \u0111o\u1ea1n s\u1edbm \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb trastuzumab v\u1edbi li\u1ec1u t\u1ea3i kh\u1edfi \u0111\u1ea7u l\u00e0 8 mg\/kg, sau \u0111\u00f3 l\u00e0 li\u1ec1u duy tr\u00ec 6 mg\/kg m\u1ed7i ba tu\u1ea7n cho th\u1ea5y n\u1ed3ng \u0111\u1ed9 th\u1ea5p nh\u1ea5t \u0111\u1ea1t \u0111\u01b0\u1ee3c \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh l\u00e0 63 mg\/L, t\u1ea1i v\u00f2ng \u0111i\u1ec1u tr\u1ecb 13. N\u1ed3ng \u0111\u1ed9 n\u00e0y t\u01b0\u01a1ng \u0111\u01b0\u01a1ng v\u1edbi n\u1ed3ng \u0111\u1ed9 ghi nh\u1eadn tr\u01b0\u1edbc \u0111\u00e2y tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n b\u1ecb ung th\u01b0 v\u00fa di c\u0103n.<\/p>\n<p>Vi\u1ec7c d\u00f9ng c\u00e1c thu\u1ed1c h\u00f3a tr\u1ecb ph\u1ed1i h\u1ee3p (ho\u1eb7c anthracycline\/cyclophosphamide ho\u1eb7c paclitaxel ho\u1eb7c docetaxel) kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a trastuzumab. Vi\u00eac d\u00f9ng anastrozole ph\u1ed1i h\u1ee3p c\u0169ng kh\u00f4ng \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a trastuzumab.<\/p>\n<p><em>Ung th\u01b0 d\u1ea1 d\u00e0y ti\u1ebfn tri\u1ec3n<\/em><\/p>\n<p><em>D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh trong ung th\u01b0 d\u1ea1 d\u00e0y ti\u1ebfn tri\u1ec3n<\/em><\/p>\n<p>Ph\u01b0\u01a1ng ph\u00e1p d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc tr\u00ean d\u00e2n s\u1ed1 s\u1eed d\u1ee5ng d\u1eef li\u1ec7u t\u1eeb nghi\u00ean c\u1ee9u BO18255 pha III, \u0111\u01b0\u1ee3c \u00e1p d\u1ee5ng \u0111\u1ec3 \u0111\u00e1nh gi\u00e1 d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n ung th\u01b0 d\u1ea1 d\u00e0y ti\u1ebfn tri\u1ec3n d\u00f9ng trastuzumab m\u1ed7i 3 tu\u1ea7n v\u1edbi li\u1ec1u t\u1ea3i l\u00e0 8 mg\/kg, sau \u0111\u00f3 li\u1ec1u duy tr\u00ec m\u1ed7i 3 tu\u1ea7n l\u00e0 6 mg\/kg. Theo ph\u01b0\u01a1ng ph\u00e1p n\u00e0y, \u0111\u1ed9 thanh th\u1ea3i \u0111i\u1ec3n h\u00ecnh c\u1ee7a trastuzumab l\u00e0 0,378 l\u00edt\/ng\u00e0y v\u00e0 th\u1ec3 t\u00edch ph\u00e2n b\u1ed1 \u0111i\u1ec3n h\u00ecnh l\u00e0 3,91 l\u00edt, th\u1eddi gian b\u00e1n th\u1ea3i \u1edf tr\u1ea1ng th\u00e1i c\u00e2n b\u1eb1ng t\u01b0\u01a1ng \u1ee9ng l\u00e0 12,2 ng\u00e0y. Trung b\u00ecnh gi\u00e1 tr\u1ecb AUC \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh \u0111\u01b0\u1ee3c d\u1ef1 \u0111o\u00e1n (trong kho\u1ea3ng th\u1eddi gian 3 tu\u1ea7n \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh) l\u00e0 1030 mg.ng\u00e0y\/1, gi\u00e1 tr\u1ecb Cmax trung b\u00ecnh \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh l\u00e0 128mg\/l v\u00e0 c\u00e1c gi\u00e1 tr\u1ecb Cmin trung b\u00ecnh \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh l\u00e0 23mg\/l. N\u1ed3ng \u0111\u1ed9 \u1edf tr\u1ea1ng th\u00e1i \u1ed5n \u0111\u1ecbnh \u0111\u1ea1t \u0111\u01b0\u1ee3c sau 49 ng\u00e0y (4 l\u1ea7n th\u1eddi gian b\u00e1n th\u1ea3i \u1edf tr\u1ea1ng th\u00e1i c\u00e2n b\u1eb1ng) ho\u1eb7c x\u1ea5p x\u1ec9 7 tu\u1ea7n.<\/p>\n<p><em>D\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc \u1edf nh\u1eefng \u0111\u1ed1i t\u01b0\u1ee3ng \u0111\u1eb7c bi\u1ec7t<\/em><\/p>\n<p>C\u00e1c nghi\u00ean c\u1ee9u d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc chi ti\u1ebft \u1edf ng\u01b0\u1eddi cao tu\u1ed5i v\u00e0 nh\u1eefng ng\u01b0\u1eddi suy gan ho\u1eb7c suy th\u1eadn ch\u01b0a \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh.<\/p>\n<p><em>Ng\u01b0\u1eddi gi\u00e0<\/em><\/p>\n<p>Tu\u1ed5i t\u00e1c kh\u00f4ng c\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn \u0111\u1eb7c t\u00ednh d\u01b0\u1ee3c \u0111\u1ed9ng c\u1ee7a trastuzumab (xem ph\u1ea7n Li\u1ec1u l\u01b0\u1ee3ng v\u00e0 C\u00e1ch d\u00f9ng)..<\/p>\n<h2><span class=\"ez-toc-section\" id=\"53-giai-thich\"><\/span>5.3 Gi\u1ea3i th\u00edch:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Ch\u01b0a c\u00f3 th\u00f4ng tin. \u0110ang c\u1eadp nh\u1eadt.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"54-thay-the-thuoc\"><\/span>5.4 Thay th\u1ebf thu\u1ed1c :<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Ch\u01b0a c\u00f3 th\u00f4ng tin. \u0110ang c\u1eadp nh\u1eadt.<\/p>\n<p><strong><em>*L\u01b0u \u00fd:<\/em><\/strong><\/p>\n<p><strong><em>C\u00e1c th\u00f4ng tin v\u1ec1 thu\u1ed1c tr\u00ean Pharmog.com ch\u1ec9 mang t\u00ednh ch\u1ea5t tham kh\u1ea3o &#8211; Khi d\u00f9ng thu\u1ed1c c\u1ea7n tuy\u1ec7t \u0111\u1ed1i tu\u00e2n theo theo h\u01b0\u1edbng d\u1eabn c\u1ee7a B\u00e1c s\u0129 <\/em><\/strong><\/p>\n<p><strong><em>Ch\u00fang t\u00f4i kh\u00f4ng ch\u1ecbu tr\u00e1ch nhi\u1ec7m v\u1ec1 b\u1ea5t c\u1ee9 h\u1eadu qu\u1ea3 n\u00e0o x\u1ea3y ra do t\u1ef1 \u00fd d\u00f9ng thu\u1ed1c d\u1ef1a theo c\u00e1c th\u00f4ng tin tr\u00ean Pharmog.com<\/em><\/strong><\/p>\n<p><script src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js?client=ca-pub-5528370293090692\" async=\"\" crossorigin=\"anonymous\"><\/script><ins class=\"adsbygoogle\" style=\"display: block; text-align: center;\" data-ad-layout=\"in-article\" data-ad-format=\"fluid\" data-ad-client=\"ca-pub-5528370293090692\" data-ad-slot=\"8909623906\"><\/ins><script> (adsbygoogle = window.adsbygoogle || []).push({}); <\/script><\/p>\n<h1><span class=\"ez-toc-section\" id=\"6-phan-thong-tin-kem-theo-cua-thuoc\"><\/span>6. Ph\u1ea7n th\u00f4ng tin k\u00e8m theo c\u1ee7a thu\u1ed1c:<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<h2><span class=\"ez-toc-section\" id=\"61-danh-muc-ta-duoc\"><\/span>6.1. Danh m\u1ee5c t\u00e1 d\u01b0\u1ee3c:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Histidine hydrochloride monohydrate ; Histidine; Trehalose dihydrate; Polysorbate 20.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"62-tuong-ky\"><\/span>6.2. T\u01b0\u01a1ng k\u1ef5 :<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Ch\u01b0a ghi nh\u1eadn c\u00f3 s\u1ef1 kh\u00f4ng t\u01b0\u01a1ng th\u00edch gi\u1eefa trastuzumab v\u00e0 t\u00fai polyvinylchloride hay polyethylene.<\/p>\n<p>Kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng dung d\u1ecbch Dextrose 5% v\u00ec n\u00f3 c\u00f3 th\u1ec3 g\u00e2y k\u1ebft t\u1ee7a protein.<\/p>\n<p>Kh\u00f4ng n\u00ean pha hay h\u00f2a tan trastuzumab v\u1edbi nh\u1eefng thu\u1ed1c kh\u00e1c.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"63-bao-quan\"><\/span>6.3. B\u1ea3o qu\u1ea3n:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>B\u1ea3o qu\u1ea3n l\u1ea1nh \u1edf nhi\u1ec7t \u0111\u1ed9 t\u1eeb 2 &#8211; 8 \u00b0C, tr\u00e1nh \u00e1nh s\u00e1ng. Kh\u00f4ng \u0111\u00f4ng l\u1ea1nh.<\/p>\n<p>Kh\u00f4ng n\u00ean s\u1eed d\u1ee5ng thu\u1ed1c qu\u00e1 h\u1ea1n d\u00f9ng in tr\u00ean h\u1ed9p, s\u1eed d\u1ee5ng dung d\u1ecbch sau khi ho\u00e0n nguy\u00ean ngay l\u1eadp t\u1ee9c v\u00e0 lo\u1ea1i b\u1ecf ph\u1ea7n thu\u1ed1c ch\u01b0a d\u00f9ng. Kh\u00f4ng \u0111\u01b0\u1ee3c \u0111\u1ec3 \u0111\u00f4ng l\u1ea1nh thu\u1ed1c sau khi ho\u00e0n nguy\u00ean, v\u1ec1 m\u1eb7t vi sinh h\u1ecdc, dung d\u1ecbch truy\u1ec1n Herticad n\u00ean \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng ngay l\u1eadp t\u1ee9c. S\u1ea3n ph\u1ea9m n\u00e0y kh\u00f4ng \u0111\u01b0\u1ee3c l\u01b0u tr\u1eef sau khi pha lo\u00e3ng tr\u1eeb khi \u0111i\u1ec1u n\u00e0y \u0111\u00e3 di\u1ec5n ra trong \u0111i\u1ec1u ki\u1ec7n v\u00f4 tr\u00f9ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t v\u00e0 x\u00e1c nh\u1eadn. N\u1ebfu kh\u00f4ng s\u1eed d\u1ee5ng ngay ng\u01b0\u1eddi s\u1eed d\u1ee5ng ph\u1ea3i ch\u1ecbu tr\u00e1ch nhi\u1ec7m v\u1ec1 th\u1eddi gian v\u00e0 \u0111i\u1ec1u ki\u1ec7n b\u1ea3o qu\u1ea3n tr\u01b0\u1edbc khi s\u1eed d\u1ee5ng, th\u01b0\u1eddng kh\u00f4ng v\u01b0\u1ee3t qu\u00e1 24 gi\u1edd \u1edf nhi\u1ec7t \u0111\u1ed9 2 &#8211; 8 \u00b0C, tr\u1eeb khi thao t\u00e1c ho\u00e0n nguy\u00ean v\u00e0 pha lo\u00e3ng \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u1edf nh\u1eefng \u0111i\u1ec1u ki\u1ec7n v\u00f4 tr\u00f9ng \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t v\u00e0 th\u1ea9m \u0111\u1ecbnh.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"64-thong-tin-khac\"><\/span>6.4. Th\u00f4ng tin kh\u00e1c :<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><em>An to\u00e0n ti\u1ec1n l\u00e2m s\u00e0ng<\/em><\/p>\n<p><em>T\u00ednh g\u00e2y qu\u00e1i thai<\/em><\/p>\n<p>C\u00e1c nghi\u00ean c\u1ee9u v\u1ec1 t\u00ednh sinh s\u1ea3n \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh tr\u00ean kh\u1ec9 cynomolgus v\u1edbi Trastuzumab t\u1ea1i li\u1ec1u g\u1ea5p 25 l\u1ea7n li\u1ec1u duy tr\u00ec \u1edf ng\u01b0\u1eddi l\u00e0 2mg\/kg v\u00e0 cho th\u1ea5y kh\u00f4ng c\u00f3 b\u1eb1ng ch\u1ee9ng n\u00e0o v\u1ec1 suy gi\u1ea3m kh\u1ea3 n\u0103ng sinh s\u1ea3n ho\u1eb7c c\u00f3 h\u1ea1i cho thai. Tuy nhi\u00ean, khi \u0111\u00e1nh gi\u00e1 nguy c\u01a1 v\u1ec1 \u0111\u1ed9c t\u00ednh sinh s\u1ea3n \u1edf ng\u01b0\u1eddi, n\u00ean c\u00e2n nh\u1eafc \u00fd ngh\u0129a c\u1ee7a th\u1ee5 th\u1ec3 HER2 \u1edf lo\u00e0i g\u1eadm nh\u1ea5m tr\u00ean s\u1ef1 ph\u00e1t tri\u1ec3n ph\u00f4i b\u00ecnh th\u01b0\u1eddng v\u00e0 s\u1ef1 ch\u1ebft ph\u00f4i \u1edf chu\u1ed9t b\u1ecb \u0111\u1ed9t bi\u1ebfn thi\u1ebfu th\u1ee5 th\u1ec3 n\u00e0y. \u0110\u00e3 ghi nh\u1eadn trastuzumab truy\u1ec1n qua nhau thai trong giai \u0111o\u1ea1n ph\u00e1t tri\u1ec3n thai s\u1edbm (ng\u00e0y th\u1ee5 thai th\u1ee9 20-50) v\u00e0 giai \u0111o\u1ea1n mu\u1ed9n (ng\u00e0y th\u1ee5 thai 120-150).<\/p>\n<p><em>C\u00e1c \u0111\u1ed9c t\u00ednh kh\u00e1c<\/em><\/p>\n<p><em>B\u00e0 m\u1eb9 cho con b\u00fa<\/em><\/p>\n<p>M\u1ed9t nghi\u00ean c\u1ee9u \u0111\u01b0\u1ee3c ti\u1ebfn h\u00e0nh \u1edf kh\u1ec9 cynomolgus \u0111ang cho con b\u00fa t\u1ea1i li\u1ec1u g\u1ea5p 25 l\u1ea7n li\u1ec1u duy tr\u00ec h\u00e0ng tu\u1ea7n \u1edf ng\u01b0\u1eddi l\u00e0 Trastuzumab 2mg\/kg cho th\u1ea5y trastuzumab \u0111\u01b0\u1ee3c ti\u1ebft qua s\u1eefa m\u1eb9. S\u1ef1 hi\u1ec7n di\u1ec7n c\u1ee7a trastuzumab trong huy\u1ebft thanh kh\u1ec9 con kh\u00f4ng g\u00e2y b\u1ea5t c\u1ee9 t\u00e1c d\u1ee5ng b\u1ea5t l\u1ee3i n\u00e0o l\u00ean s\u1ef1 t\u0103ng tr\u01b0\u1edfng v\u00e0 ph\u00e1t tri\u1ec3n t\u1eeb l\u00fac sinh cho \u0111\u1ebfn 1 th\u00e1ng tu\u1ed5i.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"65-tai-lieu-tham-khao\"><\/span>6.5 T\u00e0i li\u1ec7u tham kh\u1ea3o:<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>D\u01b0\u1ee3c Th\u01b0 Qu\u1ed1c Gia Vi\u1ec7t Nam<\/p>\n<p>D\u01b0\u1ee3c Th\u01b0 Qu\u1ed1c Gia Vi\u1ec7t Nam<\/p>\n<p>Ho\u1eb7c HDSD Thu\u1ed1c.<\/p>\n<h1><span class=\"ez-toc-section\" id=\"7-nguoi-dang-tai-tac-gia\"><\/span>7. Ng\u01b0\u1eddi \u0111\u0103ng t\u1ea3i \/T\u00e1c gi\u1ea3:<span class=\"ez-toc-section-end\"><\/span><\/h1>\n<p>B\u00e0i vi\u1ebft \u0111\u01b0\u1ee3c s\u01b0u t\u1ea7m ho\u1eb7c vi\u1ebft b\u1edfi: <a href=\"https:\/\/pharmog.com\/wp\/thong-tin-tac-gia-bac-sy-do-my-linh\/\">B\u00e1c s\u0129 nhi khoa &#8211; \u0110\u1ed7 M\u1ef9 Linh.<\/a><\/p>\n<p>Ki\u1ec3m duy\u1ec7t , hi\u1ec7u \u0111\u00ednh v\u00e0 \u0111\u0103ng t\u1ea3i: <a href=\"https:\/\/pharmog.com\/wp\/thong-tin-ve-pharmog-team\/\">PHARMOG TEAM<\/a><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Thu\u1ed1c Herticad l\u00e0 thu\u1ed1c g\u00ec ? D\u01b0\u1edbi \u0111\u00e2y l\u00e0 n\u1ed9i dung t\u1edd h\u01b0\u1edbng d\u1eabn s\u1eed d\u1ee5ng g\u1ed1c c\u1ee7a Thu\u1ed1c Herticad (Th\u00f4ng tin bao g\u1ed3m li\u1ec1u d\u00f9ng, c\u00e1ch d\u00f9ng, ch\u1ec9 \u0111\u1ecbnh, ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh, th\u1eadn tr\u1ecdng, d\u01b0\u1ee3c l\u00fd&#8230;) 1. T\u00ean ho\u1ea1t ch\u1ea5t v\u00e0 bi\u1ec7t d\u01b0\u1ee3c: Ho\u1ea1t ch\u1ea5t : Trastuzumab Ph\u00e2n lo\u1ea1i: Thu\u1ed1c ch\u1ed1ng ung th\u01b0. Nh\u00f3m [&hellip;]<\/p>\n","protected":false},"author":8612,"featured_media":37457,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"default","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"default","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[419],"tags":[1478],"class_list":["post-37455","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-biet-duoc","tag-trastuzumab"],"_links":{"self":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/37455","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/users\/8612"}],"replies":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/comments?post=37455"}],"version-history":[{"count":1,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/37455\/revisions"}],"predecessor-version":[{"id":37458,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/posts\/37455\/revisions\/37458"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/media\/37457"}],"wp:attachment":[{"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/media?parent=37455"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/categories?post=37455"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pharmog.com\/wp\/wp-json\/wp\/v2\/tags?post=37455"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}