Cytarabine
證據等級: L5 | 預測適應症: 9 個
## 藥師評估報告
Cytarabine 藥師筆記
一句話總結
Cytarabine (Ara-C) 是治療急性白血病的核心化療藥物，TxGNN 預測其對小細胞肺癌及原發性肺淋巴瘤有療效，這些預測有歷史臨床研究支持，但療效有限且非現代標準治療。
快速總覽
| 項目 | 內容 |
|---|---|
| 藥物名稱 | Cytarabine (阿糖胞苷, Ara-C) |
| DrugBank ID | DB00987 |
| 台灣商品名 | 複方製劑中的成分，如 Midostaurin 併用方案 |
| 原核准適應症 | 急性骨髓性白血病 (AML)、慢性淋巴球性白血病 (CLL)、與其他藥物併用 |
| 預測新適應症 | small cell lung carcinoma、primary pulmonary lymphoma、well-differentiated fetal adenocarcinoma of the lung、pulmonary blastoma、myeloid leukemia、upper aerodigestive tract neoplasm、ganglioneuroblastoma (disease)、vertebral anomalies and variable endocrine and T-cell dysfunction、腹膜後腫瘤 |
| 最高預測分數 | 0.998 (small cell lung carcinoma) |
| 證據等級 | L3 (歷史臨床研究，非現代標準) |
預測適應症詳細分析
1. small cell lung carcinoma L2 99.78% 主要分析
為什麼這個預測合理？
Cytarabine 的抗腫瘤機轉支持其對多種惡性腫瘤的潛在活性：
- 核苷類似物：Cytarabine 是胞嘧啶核苷的類似物，干擾 DNA 合成
- S 期特異性：主要作用於 DNA 合成期，對快速分裂的腫瘤細胞有選擇性
- 廣譜活性：歷史上曾用於多種惡性腫瘤的探索性治療
臨床試驗
| 試驗編號 | 階段 | 狀態 | 人數 | 主要發現 |
|---|---|---|---|---|
| NCT03507244 | PHASE1, PHASE2 | COMPLETED | 34 | Intrathecal-pemetrexed Combined With Concurrent Involved-field Radiotherapy for ... |
| NCT00863512 | PHASE3 | TERMINATED | 34 | A Randomized Phase III Trial of Adjuvant Chemotherapy in Patients With Early Sta... |
| NCT03101579 | PHASE1 | COMPLETED | 13 | Intrathecal Pemetrexed for Recurrent Leptomeningeal Metastasis From Non-small Ce... |
相關文獻
| PMID | 年份 | 類型 | 期刊 | 主要發現 |
|---|---|---|---|---|
| 32183950 | 2020 | Article | Cancer cell | ADORA1 Inhibition Promotes Tumor Immune Evasion by Regulating the ATF3-PD-L1 Axi... |
| 38377785 | 2024 | Article | ESMO open | Efficacy and safety of intrathecal pemetrexed for TKI-failed leptomeningeal meta... |
| 348088 | 1978 | Article | Antibiotics and chemotherapy | ARA-C analogs. |
| 9561978 | 1998 | Article | Archives of neurology | Carcinoma meningitis secondary to non-small cell lung cancer: combined modality ... |
| 232239 | 1979 | Article | Medical and pediatric oncology | Combination radiotherapy and chemotherapy for small cell carcinoma of the lung. |
| 2157307 | 1990 | Article | Tumori | Phase II trial of cytarabine, cisplatin and vindesine for advanced non-small cel... |
| 28223673 | 2017 | Article | Gan to kagaku ryoho. Cancer & | [A Case of Meningeal Carcinomatosis and Small Cell Lung Carcinoma Effectively Tr... |
| 6264785 | 1981 | Article | The American journal of medici | Meningeal carcinomatosis in small cell carcinoma of the lung. |
| 2156598 | 1990 | Article | Cancer | A phase II trial of high-dose cytarabine and cisplatin in previously untreated n... |
| 1360876 | 1992 | Article | Cancer chemotherapy and pharma | Doxorubicin sensitivity pattern in a panel of small-cell lung-cancer cell lines:... |
| 2820740 | 1987 | Article | European journal of cancer & c | Cisplatin and cytarabine combination chemotherapy of advanced non-small cell lun... |
| 18600541 | 2008 | Article | Nucleosides, nucleotides & nuc | Immunocytochemical detection of hENT1 and hCNT1 in normal tissues, lung cancer c... |
| 9363869 | 1997 | Article | Journal of clinical oncology : | Randomized trial of chemotherapy and radiation therapy with or without warfarin ... |
| 3030547 | 1987 | Article | Cancer treatment reports | High-dose cytarabine in small cell lung cancer. |
| 11331076 | 2001 | Article | Biochemical pharmacology | Collateral sensitivity to gemcitabine (2',2'-difluorodeoxycytidine) and cytosine... |
| 23422833 | 2013 | Article | Journal of thoracic oncology : | Analysis of treatment outcomes of intraventricular chemotherapy in 105 patients ... |
| 14653877 | 2002 | Article | Clinical lung cancer | Hypersensitivity pneumonitis in advanced non-small-cell lung cancer patients rec... |
| 6095640 | 1984 | Article | American journal of clinical o | Intensive cytosine arabinoside therapy in small cell carcinoma of the lung. |
| 75105 | 1978 | Article | European journal of cancer | Phase II study of anhydro-ara-5-fluorocytidine in adenocarcinoma of gastrointest... |
| 2841844 | 1988 | Article | American journal of clinical o | Etoposide (VP-16) and cytosine arabinoside in the treatment of relapsed small-ce... |
2. primary pulmonary lymphoma L2 99.78%
臨床試驗（7 項）
| 試驗編號 | 階段 | 狀態 | 人數 | 主要發現 |
|---|---|---|---|---|
| NCT00345865 | PHASE2 | COMPLETED | 473 | Autologous Peripheral Blood Stem Cell Transplant for Patients With Lymphoma |
| NCT01476839 | PHASE1 | COMPLETED | 25 | Phase I Study of Yttrium-90 Labeled Anti-CD25 (a-Tac) Monoclonal Antibody Plus B... |
| NCT02356159 | PHASE1, PHASE2 | COMPLETED | 34 | A Phase I/II Open Label, Dose Escalation Study of Palifermin (Kepivance) in Pers... |
| NCT00013533 | EARLY_PHASE1 | COMPLETED | 30 | Pilot Study of Non-Myeloablative, HLA-Matched Allogeneic Stem Cell Transplantati... |
| NCT00452374 | PHASE1, PHASE2 | COMPLETED | 48 | A Phase I-II Study of Oxaliplatin, Fludarabine, Cytarabine and Rituximab in Pati... |
| NCT02443077 | PHASE3 | ACTIVE_NOT_RECRUITING | 94 | A Randomized Double-Blind Phase III Study of Ibrutinib During and Following Auto... |
| NCT02280525 | PHASE1 | COMPLETED | 8 | A Study of Umbilical Cord Blood-Derived Natural Killer Cells in Conjunction With... |
相關文獻（20 篇）
| PMID | 年份 | 類型 | 期刊 | 主要發現 |
|---|---|---|---|---|
| 26256690 | 2017 | Article | The clinical respiratory journ | Synchronous mantle cell lymph node lymphoma and pulmonary adenocarcinoma: a case... |
| 15957966 | 2005 | Article | Expert opinion on pharmacother | Management of leptomeningeal malignancy. |
| 12860951 | 2003 | Article | Journal of clinical oncology : | Chemotherapy alone as initial treatment for primary CNS lymphoma in patients old... |
| 11244328 | 2001 | Article | Oncology | Combined treatment with high-dose methotrexate, vincristine and procarbazine, wi... |
| 38555923 | 2024 | Article | The Lancet. Haematology | Anti-CD30 CAR T cells as consolidation after autologous haematopoietic stem-cell... |
| 12241119 | 2002 | Article | Journal of neuro-oncology | Combination chemotherapy with high-dose methotrexate and cytarabine with or with... |
| 41117344 | 2025 | Article | Hematological oncology | Randomized Phase II Study of Brentuximab-Vedotin With High-Dose Chemotherapy in ... |
| 29217775 | 2018 | Article | Haematologica | Chemotherapy-induced differential cell cycle arrest in B-cell lymphomas affects ... |
| 11380234 | 2001 | Article | International journal of radia | CHOD/BVAM regimen plus radiotherapy in patients with primary CNS non-Hodgkin's l... |
| 7804123 | 1994 | Article | Stem cells (Dayton, Ohio) | Intensive therapy and autotransplantation in Hodgkin's disease. |
| 27165090 | 2016 | Article | Annals of hematology | Modified BEAM with triple autologous stem cell transplantation for patients with... |
| 37886671 | 2023 | Article | Case reports in hematology | Central Nervous System (CNS) T-Cell Lymphoma as the Presenting Manifestation of ... |
| 38024477 | 2023 | Article | EClinicalMedicine | BendaEAM versus BEAM as conditioning regimen for ASCT in patients with relapsed ... |
| 31410599 | 2020 | Article | Supportive care in cancer : of | Invasive mucormycosis during treatment for acute lymphoblastic leukaemia-success... |
| 6381657 | 1984 | Article | Journal of clinical oncology : | High-dose polychemotherapy with autologous bone marrow transplantation in childr... |
| 39935703 | 2025 | Article | Journal of hematology | Low Rate of Central Nervous System Relapse of Diffuse Large B-Cell Lymphoma Desp... |
| 2233520 | 1990 | Article | Medical and pediatric oncology | Phase II study of MOPLACE chemotherapy for patients with previously treated Hodg... |
| 10340048 | 1999 | Article | Japanese journal of clinical o | Second lung adenocarcinoma after combination chemotherapy in two patients with p... |
| 1635613 | 1992 | Article | Der Nervenarzt | [Diagnosis and therapy of meningosis neoplastica]. |
| 11062945 | 2000 | Article | Harefuah | [High-dose chemotherapy and autologous stem cell transplantation for refractory ... |
3. well-differentiated fetal adenocarcinoma of the lung L5 99.76%
目前尚無針對此適應症的專門臨床研究。此為 TxGNN 模型預測結果，需進一步驗證。
4. pulmonary blastoma L5 99.76%
目前尚無針對此適應症的專門臨床研究。此為 TxGNN 模型預測結果，需進一步驗證。
5. upper aerodigestive tract neoplasm L4 99.49%
相關文獻（20 篇）
| PMID | 年份 | 類型 | 期刊 | 主要發現 |
|---|---|---|---|---|
| 32183950 | 2020 | Article | Cancer cell | ADORA1 Inhibition Promotes Tumor Immune Evasion by Regulating the ATF3-PD-L1 Axi... |
| 16041392 | 2005 | Article | The pharmacogenomics journal | Genetic factors influencing pyrimidine-antagonist chemotherapy. |
| 36656600 | 2023 | Article | JAMA oncology | Malignant Neoplasms of the Gastrointestinal Tract After Blood or Marrow Transpla... |
| 2589230 | 1989 | Article | American journal of clinical o | Combination chemotherapy with cytosine arabinoside (Ara-C) and cis-diamminedichl... |
| 15548350 | 2004 | Article | Neoplasia (New York, N.Y.) | Chemotherapy-induced and/or radiation therapy-induced oral mucositis--complicati... |
| 7803905 | 1994 | Article | Bailliere's clinical haematolo | Therapy of Burkitt and other B-cell acute lymphoblastic leukaemia and lymphoma: ... |
| 9588546 | 1998 | Article | Neurosurgery | Chemotherapy for advanced esthesioneuroblastoma: the Mayo Clinic experience. |
| 31689961 | 2019 | Article | International journal of molec | The Association and Significance of p53 in Gynecologic Cancers: The Potential of... |
| 4515579 | 1973 | Article | Annales d'oto-laryngologie et | [Otitis and leukemia]. |
| 33619101 | 2021 | Article | Proceedings of the National Ac | Depletion of H3K36me2 recapitulates epigenomic and phenotypic changes induced by... |
| 1332622 | 1992 | Article | Gan to kagaku ryoho. Cancer & | [New antitumor antimetabolites--gemcitabine and DMDC]. |
| 16865683 | 2008 | Article | Pediatric blood & cancer | Parotid acinar cell carcinoma in a long-term survivor of childhood acute lymphob... |
| 33120806 | 2020 | Article | Medicine | Clinical characteristics and management of primary granulocytic sarcoma of the o... |
| 4623637 | 1972 | Article | The Journal of general virolog | The polypeptides of adenovirus-infected cells. |
| 12110494 | 2002 | Article | European journal of cancer (Ox | Use of high-dose cytarabine to enhance cisplatin cytotoxicity-effects on the res... |
| 22036054 | 2012 | Article | Human pathology | Therapy-related acute leukemia with mixed phenotype and t(9;22)(q32;q11.2): a ca... |
| 37227522 | 2023 | Article | Journal of cancer research and | Identification of a distinct tumor endothelial cell-related gene expression sign... |
| 12808655 | 2003 | Article | Head & neck | Radiation therapy for esthesioneuroblastoma: rationale for elective neck irradia... |
| 1279038 | 1976 | Article | International journal of cance | Relapse in Burkitt's lymphoma. |
| 25933603 | 2015 | Article | BMC research notes | Plasmablastic lymphoma of the oral cavity with breast recurrence: a case report. |
6. ganglioneuroblastoma (disease) L5 99.36%
目前尚無針對此適應症的專門臨床研究。此為 TxGNN 模型預測結果，需進一步驗證。
7. vertebral anomalies and variable endocrine and T-cell dysfunction L5 99.32%
目前尚無針對此適應症的專門臨床研究。此為 TxGNN 模型預測結果，需進一步驗證。
8. retroperitoneal neoplasm L3 99.23%
臨床試驗（1 項）
| 試驗編號 | 階段 | 狀態 | 人數 | 主要發現 |
|---|---|---|---|---|
| NCT01468311 | PHASE1, PHASE2 | TERMINATED | 6 | Phase I/II Trial of Yttrium-90-labeled Daclizumab (Anti-CD25) Radioimmunotherapy... |
相關文獻（14 篇）
| PMID | 年份 | 類型 | 期刊 | 主要發現 |
|---|---|---|---|---|
| 34733617 | 2021 | Article | World journal of clinical onco | Gastric myeloid sarcoma: A case report. |
| 12656749 | 2003 | Article | European journal of haematolog | Acute myeloid leukemia mimicking primary testicular neoplasm. Presentation of a ... |
| 16632190 | 2007 | Article | European urology | Retroperitoneal fibrosis after chemotherapy. |
| 28579851 | 2017 | Article | Clinical medicine insights. Bl | Transformation of Follicular Lymphoma to a High-Grade B-Cell Lymphoma With MYC a... |
| 2049752 | 1991 | Article | Cancer | Improved treatment results in boys with overt testicular relapse during or short... |
| 39588445 | 2024 | Article | Cureus | Cervical Granulocytic Sarcoma Without Acute Leukemia: A Case Report and Review o... |
| 6188011 | 1983 | Article | Lancet (London, England) | Further advances in the management of malignant teratomas of the testis and othe... |
| 1373636 | 1992 | Article | European journal of cancer (Ox | POMB/ACE chemotherapy in non-seminomatous germ cell tumours: outcome and importa... |
| 18725922 | 2008 | Article | Nature clinical practice. Onco | The impact of histopathologic diagnosis on the proper management of testis neopl... |
| 3875394 | 1985 | Article | Cancer | Retroperitoneal mass presentations of B-immunoblastic sarcoma. |
| 17617785 | 2007 | Article | American journal of hematology | Thalidomide for the treatment of histiocytic sarcoma after hematopoietic stem ce... |
| 41366933 | 2025 | Article | Medicine | Extensive myeloid sarcoma presenting with esophageal compression and dysphagia a... |
| 9174826 | 1997 | Article | European journal of gynaecolog | Salvage intraperitoneal therapy of advanced epithelial ovarian cancer: impact of... |
| 65223 | 1976 | Article | Cancer treatment reports | Phase 1-11 study of DTIC and cyclocytidine in disseminated malignant melanoma. |
9. neuroblastoma L2 99.19%
臨床試驗（5 項）
| 試驗編號 | 階段 | 狀態 | 人數 | 主要發現 |
|---|---|---|---|---|
| NCT04029688 | PHASE1, PHASE2 | TERMINATED | 38 | A Phase I/II, Multicenter, Open-Label, Multi-Arm Study Evaluating the Safety, To... |
| NCT03236857 | PHASE1 | COMPLETED | 143 | A Phase 1 Study of the Safety and Pharmacokinetics of Venetoclax in Pediatric an... |
| NCT02130869 | PHASE1 | COMPLETED | 8 | A Pilot Study of Immunotherapy Including Haploidentical NK Cell Infusion Followi... |
| NCT01546038 | PHASE2 | COMPLETED | 255 | A PHASE 1B/2 STUDY TO EVALUATE THE SAFETY AND EFFICACY OF PF-04449913, AN ORAL H... |
| NCT06942039 | EARLY_PHASE1 | RECRUITING | 15 | A Pilot Study of Intrathecal Topotecan and Maintenance Chemotherapy in the Post-... |
相關文獻（20 篇）
| PMID | 年份 | 類型 | 期刊 | 主要發現 |
|---|---|---|---|---|
| 36688816 | 2023 | Article | ACS applied materials & interf | Green Light-Triggerable Chemo-Photothermal Activity of Cytarabine-Loaded Polymer... |
| 15867251 | 2005 | Article | Clinical cancer research : an | Sensitivity to gemcitabine and its metabolizing enzymes in neuroblastoma. |
| 31681584 | 2019 | Article | Frontiers in oncology | Two Receptors, Two Isoforms, Two Cancers: Comprehensive Analysis of KIT and TrkA... |
| 7529082 | 1993 | Article | Cancer biotherapy | Sensitivity to bleomycin and arabinoside cytosine in lymphocytes of patients aff... |
| 2917605 | 1989 | Article | Experimental cell research | Morphologic and phenotypic changes of human neuroblastoma cells in culture induc... |
| 8070034 | 1994 | Article | Cancer chemotherapy and pharma | Epipodophyllotoxins in the treatment of childhood cancer. |
| 12471622 | 2003 | Article | International journal of cance | Cyclopentenyl cytosine primes SK-N-BE(2)c neuroblastoma cells for cytarabine tox... |
| 1751963 | 1991 | Article | Cellular and molecular neurobi | Gamma-interferon, retinoic acid, and cytosine arabinoside induce neuroblastoma d... |
| 1358448 | 1992 | Article | Cellular and molecular neurobi | A combined evaluation of biochemical and morphological changes during human neur... |
| 9588546 | 1998 | Article | Neurosurgery | Chemotherapy for advanced esthesioneuroblastoma: the Mayo Clinic experience. |
| 10402221 | 1999 | Article | Neurochemistry international | Distinct mechanisms underlay DNA disintegration during apoptosis induced by geno... |
| 34710216 | 2022 | Article | Blood advances | CPX-351 induces remission in newly diagnosed pediatric secondary myeloid maligna... |
| 3316512 | 1987 | Article | Journal of clinical oncology : | Coordinated use of sequentially escalated cyclophosphamide and cell-cycle-specif... |
| 17691910 | 2007 | Article | Current cancer drug targets | Cyclopentenyl cytosine (CPEC): an overview of its in vitro and in vivo activity. |
| 9394364 | 1997 | Article | Oncology (Williston Park, N.Y. | Clinical status and optimal use of topotecan. |
| 7576981 | 1995 | Article | European journal of cancer (Ox | Antiproliferative potential of cytostatic drugs on neuroblastoma cells in vitro. |
| 3731152 | 1986 | Article | Cancer treatment reports | Differential drug sensitivity of human neuroblastoma cells. |
| 3005494 | 1986 | Article | Journal of neurochemistry | Effects of cell division, cell density, and cyclic nucleotides on choline acetyl... |
| 2476228 | 1989 | Article | Cell biophysics | Effect of cytidine analogs on cell growth and differentiation on a human neurobl... |
| 29571866 | 2018 | Article | Journal of the neurological sc | DAPK1-ERK signal mediates oxygen glucose deprivation reperfusion induced apoptos... |
台灣上市資訊
Cytarabine 在台灣主要以下列形式使用：
| 用途 | 藥品 | 說明 |
|---|---|---|
| AML 前導治療 | Midostaurin (彌多妥) 併用 | FLT3 突變陽性 AML |
| AML 鞏固治療 | 高劑量 Ara-C | 標準方案 |
| CLL 治療 | Venetoclax 併用低劑量 Ara-C | 不適合強化化療的患者 |
安全性考量
主要毒性
| 毒性類型 | 表現 | 管理 |
|---|---|---|
| 骨髓抑制 | 嚴重嗜中性球低下、血小板低下 | 監測 CBC，預防性使用 G-CSF |
| 感染 | 機會性感染風險高 | 預防性抗生素、抗黴菌藥 |
| 神經毒性 | 高劑量時可能出現小腦症狀 | 監測神經功能，調整劑量 |
| 消化道 | 黏膜炎、噁心嘔吐 | 止吐藥、口腔護理 |
| Ara-C 症候群 | 發燒、肌痛、骨痛、皮疹 | 類固醇預防 |
藥物交互作用注意
- 其他骨髓抑制藥物：毒性疊加
- Digoxin：可能降低 digoxin 吸收
- Flucytosine：競爭性拮抗
藥物-疾病注意事項 (DDSI)
資料來源：DDInter 2.0（原文內容請參閱該網站）
肝臟疾病 🟡 Moderate
- 注意事項：Cytarabine is extensively metabolized by the liver…
腎臟疾病 🟡 Moderate
- 注意事項：Cytarabine is primarily eliminated by the kidney…
Infections 🟢 Minor
- 本藥物在此情況下禁用。需定期監測。風險包括：骨髓抑制、感染。
Bone Marrow Failure Disorders 🟢 Minor
- 風險包括：骨髓抑制、出血、感染。可能有嚴重不良反應。
結論與下一步
預測評估
| 評估項目 | 小細胞肺癌 | 原發性肺淋巴瘤 |
|---|---|---|
| 機轉合理性 | 高 | 高 |
| 臨床證據 | L3 (歷史研究) | L2 (CNS 淋巴瘤有 RCT) |
| 文獻支持 | 中等但過時 | 較強（用於 CNS 淋巴瘤） |
臨床意義評估
小細胞肺癌
- 不建議臨床使用：現代 SCLC 治療已不包含 cytarabine
- 現代標準：Cisplatin/Carboplatin + Etoposide，免疫治療 (如 atezolizumab)
- 歷史價值：反映了知識圖譜能捕捉歷史用藥關聯
原發性肺淋巴瘤/CNS 淋巴瘤
- 有臨床價值：高劑量 Ara-C 是 CNS 淋巴瘤治療的重要成分
- 現代方案：通常與 MTX、rituximab 併用
- 注意事項：「原發性肺淋巴瘤」較罕見，治療通常參考全身性淋巴瘤方案
建議
- SCLC：不建議使用 cytarabine，應依循現代治療指引
- CNS 淋巴瘤：高劑量 cytarabine 仍有其角色，需由血液腫瘤專科評估
- 腦膜轉移：鞘內 cytarabine 或 liposomal cytarabine 為可選方案
整體證據等級
L3 (觀察性研究/歷史臨床經驗) - 有文獻支持但非現代標準治療
本筆記僅供研究參考，不構成醫療建議。任何用藥決策應諮詢專業醫療人員。
最後更新：2026-02-11
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引用本報告
如需引用本報告，請使用以下格式：
APA 格式：
TwTxGNN. (2026). Cytarabine老藥新用驗證報告. https://twtxgnn.yao.care/drugs/cytarabine/
BibTeX 格式：
@misc{twtxgnn_cytarabine,
title = {Cytarabine老藥新用驗證報告},
author = {TwTxGNN Team},
year = {2026},
url = {https://twtxgnn.yao.care/drugs/cytarabine/}
}
免責聲明
本報告僅供學術研究參考，不構成醫療建議。藥物使用請遵循醫師指示，切勿自行調整用藥。任何老藥新用決策需經過完整的臨床驗證與法規審查。
最後審核：2026-02-20 | 審核者：TwTxGNN Research Team
本報告僅供學術研究參考，不構成醫療建議。藥物使用請遵循醫師指示，切勿自行調整用藥。任何老藥新用決策需經過完整的臨床驗證與法規審查。
最後審核：2026-02-20 | 審核者：TwTxGNN Research Team
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