Gefitinib引起的急性間質性肺部疾病案例報告

Gefitinib是可口服、具選擇性小分子的表皮生長因子接受器(epidermal growth factor receptor, EgFR)酪胺酸激酶抑制劑(tyrosine kinase inhibitor, TKI)，抑制表皮生長因子受體的磷酸化反應，阻斷腫瘤細胞信號傳導路徑而抑制細胞的分化和存活，用於晚期非小細胞肺癌之治療。雖然Gefitinib引起的間質性肺部疾病較少見，但卻是嚴重及可能致死的副作用。本個案為71歲女性，診斷為非小細胞肺腺癌第iV期，併有左下肺葉縱隔腔淋巴結和多發性骨轉移，接受放射線及口服gefitinib (iressa)每日250 mg治療。因出現呼吸急促、呼吸困難、疲勞、咳嗽次數頻繁，及有雙下肢水腫情形，至本院急診室。並安排住院進一步治療。評估病人疾病及用藥史，疑似因gefitinib引起急性間質性肺部疾病。除給予支持性治療外，給與低劑量類固醇治療，症狀獲得改善。我們同時整理相關文獻探討此不良反應之發生風險與治療方法，以提供醫療人員臨床處置之參考。

關鍵字

藥物引起間質性肺部疾病；標靶治療藥物；類固醇

並列摘要

Gefitinib, an orally active and selective inhibitor of epidermal growth factor-receptor tyrosine kinase blocking the signal transduction pathway implicated in the proliferation and survival of cancer cells, is an effective treatment for patients with advanced non-small-cell lung cancer (NSCLC). Interstitial lung disease is a rare but potentially life-threatening complication of gefitinib therapy. This is a case of 71-year-old female who was diagnosed with adenocarcinoma in the left lower lung involving mediastinal lymph nodes and multiple bone metastases (T2bN3M1b, stage iV). The patient received radiotherapy and daily treatment with oral gefitinib (250 mg/day) was commenced. Later, she experienced shortness of breath, desaturation, dyspnea on exertion, frequent cough with few sputum production, accompanied by bilateral lower leg edema for days. She was admitted because of the impression of gefitinib-related interstitial lung disease, and gefitinib was discontinued immediately. The drug-related disease of the case was successfully treated by low dose corticosteroids. Furthermore, the findings of this research summarizes the related literature review and discusses the adverse reactions and treatment methods of patients with the gefitinib-related interstitial lung disease may provide clinicians as a reference for preventing or managing these events.

並列關鍵字

Gefitinib ； Drug-Induced Lung Disease ； Molecular-Targeted Agents ； Corticosteroids

國際替代計量

Gefitinib引起的急性間質性肺部疾病案例報告

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