- 期刊
Erlotinib引起之間質性肺炎：案例報告與文獻回顧
Erlotinib Related Interstitial Pneumonitis: Case Report with Literature Review
摘要
Erlotinib為EGFR-TKI，用於接受化學治療後仍局部惡化或轉移之肺腺癌的第二線用藥。近來陸續報導erlotinib related interstitial pneumonitis（erlotinib related IP）之案例，erlotinib related IP是一少見不良反應且其症狀容易與因肺部感染、心衰竭或肺癌惡化引起之表現混淆難以確診，需依賴影像學或有效之病理組織輔助判斷。本案例為一78歲男性持續兩日發燒與出現呼吸困難的症狀入院治療，在排除因非小細胞肺癌惡化、肺部感染或心臟衰竭等因素後，高度懷疑為erlotinib related IP，且在給予高劑量類固醇後成功脫離呼吸器之案例。依據Naranjo scale評估erlotinib與不良反應之間關聯性為5分屬於「極有可能」。回顧過去erlotinib related IP的案例報告，男性性別、抽菸史或曾接受具肺部毒性之化學治療藥品等皆為發生IP之危險因子；一旦確定IP應立即停止erlotinib，並給予類固醇及適時提供氧氣或呼吸器進行支持性療法。
並列摘要
Erlotinib is an oral EGFR-TKI used for the treatment of locally advanced or metastatic adenocarcinoma after failure to prior chemotherapy regimen. Cases of erlotinib related interstitial pneumonitis (IP) have been reported recently. Erlotinib related IP is a rare adverse reaction and difficult to diagnose due to similar symptoms caused by pulmonary infection or heart failure. Hence, the diagnosis of erlotinib related IP relies on radiologic features and biopsy study. This is a case of 78-year-old man who was admitted to the emergency room after two days of fever and dyspnea. Erlotinib related IP was highly suspected after other potential causes such as cancer progression, pulmonary infection or congestive heart failure have been excluded. The patient was extubated after high doses of corticosteroids. The correlation between erlotinib and adverse drug reaction was evaluated with the Naranjo scale, representing ＂probable＂ with a score of 5. Male sex, former smokers and previous chemotherapy with high pulmonary toxicity drugs are risk factors for development of erlotinib related IP after the literature review. Erlotinib should be discontinued and the patient was treated with steroids, oxygen or mechanical ventilator if IP is confirmed.
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