OBJECTIVE To optimize the ethanol extraction process for Danggui Jixueteng Decoction （DGJXTD） and establish its fingerprint by high-performance liquid chromatography （HPLC） coupled with principal component analysis. METHODS Reflux extraction was performed using an orthogonal experimental design， with ethanol concentration， liquid-to-material ratio， and extraction temperature selected as the investigated factors. Multiple indicators， including the contents of epicatechin， albiflorin， paeoniflorin， ferulic acid， pentagalloylglucose， lithospermic acid， salvianolic acid B， ligustilide， and dry extract yield， were integrated for comprehensive evaluation， and the analytic hierarchy process （AHP）-entropy weight method was employed to determine a composite score for extraction process optimization. Fingerprint analysis was performed on different batches of DGJXTD ethanol extracts， and chemical pattern recognition was carried out using hierarchical clustering， principal component analysis， and orthogonal partial least squares-discriminant analysis. RESULTS The optimal extraction parameters determined by the orthogonal test were 85% ethanol， a liquid-to-material ratio of 1∶8， and an extraction temperature of 90 ℃. Seventeen common peaks were identified in the established fingerprint， with similarity values exceeding 0.96 across all batches. Hierarchical clustering grouped the samples into two clusters and identified several key discriminatory components， including peak 15 （salvianolic acid B）， peak 8 （paeoniflorin）， and peak 7 （epicatechin）. CONCLUSION The optimized ethanol extraction process for DGJXTD based on the AHP-entropy weighted method was stable， feasible， and reproducible. The established fingerprint combined with chemometric analysis provided a reliable and suitable approach for quality evaluation of DGJXTD， offering a valuable reference for the refinement and improvement of its quality standards.
OBJECTIVE To elucidate the mechanism of action of Runchang Ningshen Paste （RCNSP） in treating functional constipation （FC） via the Toll-like receptor-4/nuclear factor-kappaB （TLR4/NF-κB） signaling pathway. METHODS Thirty-six rats were randomized to the control， model， RCNSP low-dose， RCNSP medium-dose， RCNSP high-dose， and lactulose groups using a random table. Except for the control group， all other groups were administered loperamide by subcutaneous injection for 7 days to induce FC. Corresponding treatments were then administered starting on Day 3. Histopathological changes in colon tissues were evaluated by hematoxylin-eosin （H&E） staining. The protein and mRNA expression levels of TLR4， NF-κB， interleukin-6 （IL-6）， and tumor necrosis factor-α （TNF-α） in colon tissues were quantified by Western blot and quantitative polymerase chain reaction （qPCR）， respectively. RESULTS Model group animals had significantly decreased fecal water content and small intestinal transit rate， along with prominent inflammatory cell infiltration and markedly upregulated mRNA and protein expression of TLR4， NF-κB， IL-6， TNF-α in the colon tissues. In contrast， RCNSP treatment increased fecal water content and small intestinal transit rate， attenuated inflammatory cell infiltration， and significantly downregulated the mRNA and protein levels of these cytokines in colon tissues. CONCLUSION RCNSP exerts therapeutic effects in FC by inhibiting TLR4/NF-κB signaling， alleviating colonic inflammation and injury， and promoting intestinal motility in rats.
OBJECTIVE To establish an ultra-performance liquid chromatography （UPLC） characteristic chromatogram， determine the contents of ten components of Bushen Qiangshen Capsules （BQC）， and integrate chemometric strategies for quality evaluation. METHODS Chromatographic separation was achieved on an ACQUITY UPLC HSS T3 column （2.1 mm×100 mm， 1.8 μm） with a mobile phase consisting of acetonitrile and 0.1% phosphoric acid aqueous solution under gradient elution. The analysis was performed at a flow rate of 0.3 mL·min–1， a column temperature of 35 ℃， and with multiple detection wavelengths. Similarity analysis was conducted to establish an UPLC characteristic chromatogram. Component contents were analyzed using clustering， principal component analysis （PCA）， and orthogonal partial least squares-discriminant analysis （OPLS-DA）. RESULTS UPLC characteristic chromatograms were established for 36 batches of BQC samples， and the 10 identified components were 5-hydroxymethylfurfural （5-HMF）， protocatechuic acid， hyperoside， salidroside， specnuezhenide， nuezhenoside G13， epimedin A， epimedin B， epimedinC and icariin. All components exhibited excellent linearity （r≥0.999 2） within their respective concentration ranges， with average recoveries ranging from 92.7% to 102.6%. Analysis of 36 BQC batches revealed notable inter-batch variability， with specnuezhenide， nuezhenide G13， total flavonol glycosides， icariin， 5-HMF， and epimedin C identified as the major differential markers through chemometric analysis. CONCLUSION The established UPLC method is stable and reliable， and provides valuable insight to the quality control of BQC.
OBJECTIVE To evaluate the effect of Xuanfuhua Decoction （XFHD） on bile acid metabolism and farnesoid X Receptor-small heterodimer partner （FXR-SHP） signaling in metabolic dysfunction-associated steatohepatitis （MASH）. METHODS Twenty-four male C57BL/6J mice were randomly divided into the normal control， MASH， XFHD （14.19 g·kg–1）， and positive control （obeticholic acid， 10 mg·kg–1） groups. After 24 weeks of a high-fat， high-fructose， and high-cholesterol diet， mice were orally gavaged with the corresponding treatments for 6 weeks. Drug-containing sera were prepared， and AML12 cells were induced with free fatty acids （FFA） with or without the FXR inhibitor Guggulsterone. Serum levels of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， total cholesterol （TC）， triglycerides （TG）， and low-density lipoprotein cholesterol （LDL-C） were measured. Histopathological changes in the liver were assessed by hematoxylin and eosin （HE）， Oil Red O， and Sirius Red staining， and bile acid profiles were analyzed by mass spectrometry. FXR and SHP mRNA and protein levels were measured by quantitative PCR （qPCR） and Western blot， respectively. Molecular docking was performed to predict the binding affinity between the active components of XFHD and FXR， and the regulatory effects of high-affinity components on FXR mRNA expression were further validated through in vitro assays. RESULTS XFHD significantly reduced serum ALT， AST， TC， TG， and LDL-C levels （P<0.05， P<0.01）， alleviated hepatic steatosis， inflammation， and fibrosis， as well as decreased the NAS score and hepatic TG and hydroxyproline levels （P<0.05， P<0.01） in MASH mice. Bile acid profiling revealed that XFHD reversed the increase in serum levels of toxic bile acids and the decrease in intrahepatic physiological bile acids. Additionally， XFHD upregulated hepatic FXR and SHP expression （P<0.05， P<0.01）， which was inhibited in the presence of Guggulsterone. Molecular docking indicated that luteolin， chrysoeriol， and azaleatin in XFHD bound to FXR with high affinity， and in vitro assays confirmed that these components significantly upregulated FXR mRNA levels in AML12 cells （P<0.05）. CONCLUSION XFHD markedly ameliorates disruptions in bile acid metabolism in MASH via modulating the FXR-SHP signaling pathway.
OBJECTIVE To evaluate the effect and potential mechanism of action of electroacupuncture （EA） combined with Zhengan Xifeng Decoction （ZGXFD） on mitophagy in mice with Parkinson's disease （PD） via the adenosine monophosphate-activated protein kinase （AMPK）/mammalian target of rapamycin （mTOR） pathway. METHODS C57BL/6 mice were randomly divided into the control， model， EA， traditional Chinese medicine （TCM）， and EA-TCM groups， with 12 mice per group. PD was induced in mice by intragastric administration of rotenone solution. Animals in the EA group received EA once daily for 30 minutes per session， for 2 consecutive weeks. The TCM group was given an intragastric administration of GZXFD at a dose of 25 g·kg–1·d–1. The EA-TCM group was given a combination of intragastric GZXFD administration and EA. Motor function of mice in each group was evaluated by the pole test and hindlimb scoring. Morphological changes in the mitochondria were examined by transmission electron microscopy （TEM）. TH and α-syn positivity in the midbrain substantia nigra of mice was determined using immunohistochemistry （IHC）， whereas LC3 positivity was detected by immunofluorescence staining. Protein expression levels of p-AMPK/AMPK and p-mTOR/mTOR in the midbrain substantia nigra of mice were quantified Western blot. RESULTS Compared with the control group， the model group had prolonged total time in the pole test and increased hindlimb function scores （both P<0.01）， as well as decreased TH and LC3 positivity and increased α-syn positivity in the midbrain substantia nigra （all P<0.05）， along with upregulated p-mTOR/mTOR and downregulated p-AMPK/AMPK protein levels （both P<0.05）. Compared with the model group， all treatment groups showed significant improvements in the above parameters （all P<0.05）. Furthermore， the EA-TCM group had higher levels of TH， LC3， and p-AMPK/AMPK and lower levels of α-syn and p-mTOR/mTOR in the midbrain substantia nigra （all P<0.05） compared with either the EA group or TCM group. CONCLUSION EA combined with ZGXFD may exert neuroprotective effects in PD mice by regulating AMPK/mTOR-mediated mitophagy in the midbrain substantia nigra， eliminating abnormally aggregated α-syn and alleviating mitochondrial injury.
OBJECTIVE To systematically evaluate the safety of rechallenge with immune checkpoint inhibitors （ICIs） in cancer patients who experienced immune-mediated hepatitis （IMH） during initial ICI therapy， and to explore the characteristics of potential beneficiary populations. METHODS We systematically searched databases， including CNKI， from inception to June 9， 2025， for studies reporting ICI rechallenge after an initial episode of IMH. RevMan 5.4 and Stata 18.0 were used for the systematic review and meta-analysis of the safety of ICI rechallenge. RESULTS A total of 23 studies were included， comprising 21 retrospective studies and 2 prospective studies， with data from 399 patients with IMH who underwent rechallenge. Meta-analysis showed that the rechallenge rate after an initial episode of IMH was 39.0% （95% CI： 0.31–0.48， P<0.01）， and the recurrence rate of IMH after rechallenge was 18.0% （95% CI： 0.12–0.25， P=0.004 2）. Compared with the initial episode of IMH， ICI rechallenge significantly increased the risk of both all-grade （OR=2.20， 95% CI： 1.62–2.97， P<0.01） and high-grade （OR=2.52， 95% CI： 1.72–3.67， P<0.01） IMH， with statistically significant differences. Subgroup analysis showed that when the interval between discontinuation after the initial IMH episode and rechallenge was ≤45 d， the risk of recurrence was significantly increased. CONCLUSION ICI rechallenge significantly increases the risk of IMH recurrence， especially when the rechallenge interval is ≤45 d.
OBJECTIVE Middle-aged and older patients with pulmonary embolism are at high risk of bleeding， and the selection of novel oral factor Ⅹa inhibitors often involves a therapeutic trade-off between efficacy and safety. This study aimed to provide evidence-based support for individualized clinical decision-making. METHODS Multiple Chinese and English databases were searched for relevant randomized controlled trials （RCTs） published up to November 24， 2025. The study was registered in PROSPERO （CRD420251186099）. After assessing the methodological quality of the included literature， a network meta-analysis was performed using Stata 16.0. RESULTS A total of 28 RCTs involving 73 764 patients were included. The results showed that rivaroxaban was associated with a higher overall clinical response rate. The incidence of bleeding was lower with apixaban than with the other two drugs. The incidence of major bleeding and clinically relevant non-major bleeding was lower with edoxaban than with rivaroxaban. CONCLUSION Rivaroxaban appears to provide better clinical efficacy in middle-aged and older patients with pulmonary embolism， whereas apixaban offers a safety advantage. In clinical practice， drug selection should be individualized according to factors such as the patient’s bleeding risk.
OBJECTIVE To evaluate the cost-effectiveness of finotonlimab combined with bevacizumab as first-line treatment for advanced hepatocellular carcinoma （HCC）. METHODS From the perspective of China’s healthcare system， a partitioned survival model was developed using R software based on the latest data from a phase Ⅲ clinical study （NCT04560894） to simulate the costs and outcomes of finotonlimab combined with bevacizumab versus sorafenib in patients with advanced HCC. The time horizon was lifetime. Health outcomes were measured in quality-adjusted life years （QALYs）. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio （ICER） and compared with the willingness-to-pay （WTP） threshold， defined as three times China’s per capita gross domestic product in 2024. Robustness of the results was evaluated using one-way sensitivity analysis and probabilistic sensitivity analysis. RESULTS Compared with sorafenib， the ICER of finotonlimab combined with bevacizumab for treating advanced HCC in China was 686 402.74 yuan/QALY. One-way sensitivity analysis showed that the cost of bevacizumab and the cost of finotonlimab were the two most influential parameters after utility values. Probabilistic sensitivity analysis showed that， at the current WTP threshold， the probability that the combination regimen was cost-effective relative to sorafenib was 0. CONCLUSIONS Compared with sorafenib， the current first-line use of finotonlimab combined with bevacizumab is not cost-effective for advanced HCC in China.
OBJECTIVE To comprehensively evaluate the clinical value of toripalimab as first-line therapy in six cancers， including nasopharyngeal carcinoma （NPC）， non-squamous non-small cell lung cancer （NSCLC）， triple-negative breast cancer （TNBC）， esophageal squamous cell carcinoma （ESCC）， extensive-stage small cell lung cancer （ES-SCLC）， and renal cell carcinoma （RCC）. METHODS Based on the Technical Guidelines for Comprehensive Clinical Evaluation of Anti-tumor Drugs （Trial Version 2022）， an evaluation framework covering six dimensions， namely safety， efficacy， cost-effectiveness， innovation， suitability， and accessibility， was established. Relevant studies were systematically retrieved， and an umbrella review was conducted to synthesize evidence on efficacy and safety. Net health benefit （NHB） scores were calculated using the American Society of Clinical Oncology Value Framework version 2， and pharmacoeconomic evidence was also summarized. Four PD-1 inhibitors included in the Medicine List for National Basic Medical Insurance， Employment Injury Insurance and Maternity Insurance （2024 Edition） were quantitatively scored and compared according to the second and third editions of the Quick Guideline for Drug Evaluation and Selection in Chinese Medical Institutions. RESULTS Toripalimab demonstrated superior clinical benefit， with improvements in overall survival （OS）， progression-free survival （PFS）， and objective response rate （ORR） across all six cancer types compared with chemotherapy as a first-line treatment. Despite a slightly increased incidence of Grade 3 or higher adverse events， the safety profile of toripalimab was overall manageable. The NHB scores of toripalimab ranked among the highest compared with similar drugs for NPC， TNBC， ESCC， and RCC， although its cost-effectiveness varied across indications. Notably， evidence consistently supported the cost-effectiveness of toripalimab in NPC and NSCLC but remained controversial for TNBC， ESCC， and RCC. Toripalimab demonstrated substantial innovation and was included in the National Reimbursement Drug List as a Class B drug； however， its availability in tertiary cancer hospitals remained limited， with a national average availability rate of 41.1%. Quantitative scoring showed that toripalimab maintained00 strong overall competitiveness in most indications， with notable advantages in NPC， TNBC， ES-SCLC， and RCC. CONCLUSION Toripalimab demonstrates favorable efficacy and substantial clinical value as a first-line therapy across six cancer indications， with an overall manageable safety profile. It also shows advantages in reimbursement coverage and quantitative value assessment for selected indications， although further efforts are needed to improve its accessibility.
OBJECTIVE To analyze the clinical characteristics， imaging findings， treatment strategies， and rechallenge outcomes of acute neurotoxicity in patients with osteosarcoma after high-dose methotrexate （HD-MTX） chemotherapy， and to provide reference for clinical pharmaceutical care and treatment decision-making. METHODS Case reports of acute neurotoxicity after HD-MTX chemotherapy in patients with osteosarcoma were systematically searched in domestic and international databases. Information on patient demographics， medication use， blood drug concentrations， clinical manifestations， imaging features， treatment measures， and rechallenge outcomes was extracted and summarized for analysis. RESULTS A total of 21 patients were included， aged 6–23 years， predominantly adolescents. Neurotoxicity mostly occurred during the first to fourth chemotherapy cycles， with onset 2–14 days after administration. The main clinical manifestations were transient encephalopathy， stroke-like symptoms （hemiplegia and aphasia）， and epileptic seizures. Cranial magnetic resonance imaging （MRI） typically showed high signal intensity on diffusion-weighted imaging （DWI） in the centrum semiovale， accompanied by decreased apparent diffusion coefficient （ADC）. All patients achieved complete symptom resolution after discontinuation of HD-MTX and symptomatic treatment， such as aminophylline and dextromethorphan. Among the 13 patients with documented rechallenge， 10 （76.92%） successfully resumed HD-MTX therapy， and only 1 experienced recurrence. CONCLUSION Acute neurotoxicity induced by HD-MTX is reversible， and early recognition and timely intervention are associated with favorable outcomes. The occurrence of neurotoxicity is not an indication for permanent discontinuation of the drug. After comprehensive evaluation and implementation of preventive measures， most patients can safely receive HD-MTX again.
OBJECTIVE To compare the efficacy and safety of an oral midazolam and esketamine mixture versus oral midazolam alone for preoperative sedation in children， with respect to separation from parents and painless venipuncture. METHODS Children aged 1 to 6 years scheduled for elective surgery under general anesthesia and classified as American Society of Anesthesiologists （ASA） physical status Ⅰ to Ⅱ were enrolled and randomly assigned to the ME group or the M group. The ME group received an oral mixture of midazolam 0.41 mg·kg–1 and esketamine 4.1 mg·kg–1 before surgery， while the M group received oral midazolam solution 0.82 mg·kg–1. The following were recorded： behavioral score at drug administration； modified Ramsay sedation score every 5 min after administration； parental separation anxiety scale （PSAS） at separation from parents； emotional state scale （ESS） during venipuncture； time from successful sedation to separation； use of rescue sedation； surgical duration； recovery time； dose of anesthetic maintenance drugs； adverse reactions during sedation； and parental satisfaction. RESULTS The sedation success rate was 69.8% （37/53） in the ME group， which was higher than 26.8% （15/56） in the M group， with a statistically significant difference （P<0.01）. The separation success rate was lower in the ME group than in the M group （75.5% vs. 94.6%， P=0.005）， but the modified Ramsay sedation score during venipuncture was higher in the ME group than in the M group （P=0.002）. Regarding poor compliance during drug administration， the behavioral score was higher in the ME group than in the M group （P=0.022）. Four adverse reactions occurred in the ME group （3 cases of agitation and 1 case of vomiting）， and 2 adverse reactions occurred in the M group （2 cases of agitation）； the difference in adverse reaction rates between the two groups was not statistically significant （P=0.433）. CONCLUSION An oral midazolam and esketamine mixture for preoperative sedation in children can significantly improve the sedation success rate compared with oral midazolam alone， without increasing the incidence of adverse reactions. It is an effective and safe preoperative medication regimen.
OBJECTIVE To develop an integrated pharmacy-nursing monitoring platform for safe intravenous infusion execution based on the Total Quality Management （TQM） model， optimize the management workflow of the Pharmacy Intravenous Admixture Service （PIVAS）， and ensure medication safety for patients. METHODS A software platform was developed focusing on five key indicators： infusion transport time， infusion use within the validity period， infusion medication administration interval， infusion time for special medications， and infusion sequence for antineoplastic drugs. Real-time statistical analysis was achieved through data exchange with the hospital’s internal systems. Improvements in these indicators before and after platform implementation were compared. RESULTS After implementation of the monitoring platform， the mean transport time for prepared infusions decreased from （37.04±53.38） min to （27.11±14.19） min （P<0.05）. In four pilot departments （Cardiology， Orthopedics/Hand and Foot Surgery， Urology， and General Medicine）， the compliance rates for use within the validity period improved from （77.8±3.0）%， （97.1±1.0）%， （96.3±0.5）%， and （93.1±0.5）% before improvement to （91.9±3.0）%， （100.0±0.0）%， （99.3±0.5）%， and （98.6±1.6）% after improvement， respectively （P<0.05）. The compliance rates for infusion medication administration intervals improved from （70.2±2.7）%， （83.7±1.3）%， （62.6±7.9）%， and （47.9±3.2）% to （79.9±4.6）%， （89.5±2.5）%， （83.1±1.7）%， and （62.5±4.7）%， respectively （P<0.05）. The compliance rates for infusion time of special medications increased from （52.48±7.45）%， （50.58±2.89）%， （72.35±1.16）%， and （66.96±4.05）% to （77.36±5.17）%， （65.37±1.89）%， （78.51±3.73）%， and （85.77±5.49）%， respectively （P<0.05）. The overall hospital compliance rate for the infusion sequence of antineoplastic drugs increased from （21.8±41.7）% before improvement to （65.7±47.8）% after improvement （P<0.05）. CONCLUSION The TQM model can effectively identify infusion-related risks. This monitoring platform significantly improved compliance with infusion safety standards and enhanced the quality of medical services.
OBJECTIVE To explore the application of lean six sigma （LSS） and failure mode and effect analysis （FMEA） in constructing a clinical medication pathway for patients receiving nasogastric feeding， and to provide a reference for the development and promotion of clinical medication pathways. METHODS Using the 5-step LSS management approach， a clinical medication pathway for nasogastric drug administration was established. FMEA was applied to quantitatively identify key steps associated with medication errors based on the risk priority number. Patients receiving nasogastric feeding in the neurosurgical intensive care unit of Yuncheng Central Hospital Affiliated to Shanxi Medical University from January to March 2023 （before implementation of the medication pathway） and from January to March 2024 （after implementation） were assigned to the control group and observation group， respectively. Data were analyzed using SPSS 22.0. The pre- and post-implementation rates of rational medical orders， adverse event incidence， pharmacist recommendation acceptance， and nurse procedural compliance were compared. RESULTS After implementation of the clinical medication pathway， the rational medical order rate increased from 20.4% to 67.5%， the incidence of adverse events decreased from 49.6% to 33.1%， the pharmacist recommendation acceptance rate increased from 55.6% to 89.3%， and the nurse procedural compliance rate increased from 52.4% to 82.5%. All differences were statistically significant （P<0.05）. CONCLUSION The construction of a clinical medication pathway can effectively improve the rational use of medications in patients receiving nasogastric feeding. Continuous participation of clinical pharmacists in treatment optimization highlights the value of pharmaceutical care in clinical pathways.
Cancer is a major global public health issue， and abnormalities in the fibroblast growth factor receptor （FGFR） signaling pathway are closely associated with the onset and progression of various malignant tumors. At present， four FGFR inhibitors have been approved worldwide： pemigatinib， erdafitinib， infigratinib， and futibatinib. These agents are mainly used in cholangiocarcinoma with FGFR2 fusions or rearrangements and urothelial carcinoma with FGFR3 mutations. This article systematically reviews the mechanisms of action of FGFR inhibitors， their current clinical applications， recent advances in clinical research， resistance mechanisms and corresponding strategies， with a particular focus on key considerations during clinical use. The aim is to provide a theoretical basis and practical reference for the standardized use of FGFR inhibitors， whole-course management strategies， and the development of new agents in the future.
Primary immune thrombocytopenia （ITP） is an autoimmune disorder characterized by thrombocytopenia and an increased risk of bleeding. Romiplostim is a long-acting thrombopoietin receptor agonist （TPO-RA） that increases peripheral blood platelet counts in patients with ITP by stimulating megakaryocyte proliferation and differentiation as well as platelet production. This article reviews the clinical application of romiplostim in ITP， with a focus on the timing of use， application in special populations， dose adjustment strategies， drug switching， and tapering/discontinuation strategies， while also indicating the source of evidence according to the level of evidence. In multiple clinical studies， romiplostim is administered subcutaneously at an initial dose of 1 μg·kg–1 once weekly， and platelet counts in most patients rise to target levels （≥50×109·L–1） within 1 to 2 weeks； overall tolerability is good， although attention should be paid to adverse events such as thrombosis and bone marrow fibrosis. Evidence in special populations suggests that romiplostim also demonstrates certain efficacy and acceptable safety in pregnant/lactating women， elderly patients， and pediatric patients with ITP. When patients fail prior TPO-RA therapy， more than half may achieve a treatment response after switching to another TPO-RA. TPO-RA tapering and discontinuation should follow an individualized approach， with gradual dose reduction and monitoring of platelet counts. Future studies should focus on optimizing tapering strategies， clarifying the timing of drug switching， and identifying biomarkers that predict sustained remission， so as to improve long-term patient outcomes.
A child with an MTHFR gene mutation developed delayed methotrexate elimination and acute kidney injury after high-dose methotrexate （HD-MTX） chemotherapy. The condition improved after interventions including hydration and urine alkalinization， calcium folinate rescue， and blood purification. Based on the genetic testing results combined with therapeutic drug monitoring， the clinical pharmacist recommended a 75% reduction in the MTX dose and optimization of the rescue regimen for the second chemotherapy cycle； no further kidney injury occurred. This case suggests that MTHFR gene testing combined with therapeutic drug monitoring can guide MTX dose adjustment and rescue regimen optimization. Precision pharmaceutical care with the participation of clinical pharmacists may help reduce the risk of HD-MTX-induced kidney injury and ensure chemotherapy safety.
