Recovery from Gefitinib-induced Pneumonitis and Hepatitis after Changing to Erlotinib Treatment

Gefitinib引起的肺炎與肝炎在改換Erlotinib後恢復正常

劉濬漳(Chun-Chang Liu) ； 陳育民(Yuh-Min Chen)

《中華民國癌症醫學會雜誌》 25卷6期 (2009/12) Pp. 439-445

https://doi.org/10.6588/JCOS.2009.25.6.6

摘要

Gefitinib與erlotinib均是上皮細胞生長因素接受體－酪胺酸激酶抑制劑(EGFR-TKI)，可有效使用於非小細胞肺癌的治療。藥物引起的副作用一般均較輕微。但是，有些病患會發生急性嚴重間質性肺炎或肝炎，有時甚至引起死亡。我們報告二例病例，一例是gefitinib引起的肺炎，另一例是肝炎。在他們停止使用gefitinib後，發炎均有恢復。病患接著改用erlotinib，並沒有肺炎或肝炎的再度發生。第一個病例是58歲男性，患有第四期非小細胞肺癌，使用gefitinib當第一線治療。使用gefitinib後，病情有局部緩解。但是病患在使用gefitinib六個月後，逐漸變喘。胸部X光檢查顯示右肺有急性間質性肺炎。病患隨即停止使用gefitinib，並口服類固醇與氧氣治療。在臨床症狀改善後，改用erlotinib並沒有再發生間質性肺炎。第二例是77歲女性，患有第四期肺腺癌。也是使用gefitinib當第一線治療，病情在gefitinib使用一個月後有達局部緩解。但是患者在第二個月後發生胃口變差、噁心，合併第三度肝功能異常。在停止gefitinib二週後，肝功能逐漸恢復，她隨即改用erlotinib每日75毫克，肝功能也恢復到正常值。當使用EGFR-TKI時，須經常小心評估有無新的呼吸道或腸胃道症狀出現。當懷疑有相關副作用發生時，便立即安排相關檢查，有需要時，可以從一種EGFR-TKI換到另一種EGFR-TKI。

關鍵字

肝炎 ； 間質性肺炎 ； 非小細胞肺癌 ； 上皮細胞生長因素接受體

並列摘要

Both gefitinib and erlotinib are selective epidermal growth factor-receptor tyrosine kinase inhibitors (EGFR-TKI), and are effective in the treatment of advanced non-small-cell lung cancer (NSCLC). Drug-related adverse events are usually mild in degree when using these drugs. However, some patients may develop acute severe intersititial pneumonia or hepatitis, which is sometimes fatal. We describe herein the cases of two patients with NSCLC who suffered from gefitinib-induced acute interstitial pneumonia and hepatitis, respectively, and recovered after stopping gefitinib treatment; the patients subsequently received erlotinib treatment uneventfully. Case one was a 58-year-old man with stage Ⅳ NSCLC who received gefitinib as first-line therapy. He had a partial response after gefitinib treatment. However, progressive dyspnea occurred after six months of gefitinib therapy. Chest X-ray showed new-onset right upper and lower lobe ground-glass opacity and consolidation compatible with acute interstitial pneumonitis. Gefitinib therapy was discontinued, and the patient received oral corticosteroid and supplemental oxygen treatment. After the clinical symptoms subsided, the patient took erlotinib as second-line therapy without recurrence of pulmonary symptoms or interstitial pneumonia. Case two was a 77-year-old woman with stage IV adenocarcinoma who had received gefitinib as first-line therapy. She had a partial response to gefitinib after one month of treatment. However, the patient developed a poor appetite, nausea sensation, and grade 3 hepatitis after 2 months of treatment. After stopping gefitinib for two weeks, her liver function tests gradually improved, but did not return to normal range. She then took erlotinib (75 mg/day) as second-line therapy. She tolerated erlotinib therapy well, and liver enzymes (AST and ALT) returned to normal range again. When treating NSCLC patients with EGFR-TKI, it is important to evaluate carefully any new-onset respiratory and gastrointestinal symptoms. Arranging radiographic and hepatic examinations accordingly is needed whenever pulmonary or hepatic toxicity is suspected. Thus, a change from one EGFR-TKI to another EGFR-TKI is an appropriate choice if further EGFR-TKI treatment is still needed.

並列關鍵字

hepatitis ； interstitial pneumonia ； non-small-cell lung cancer ； epidermal growth fctor receptor