肺癌患者因严重不良反应致表皮生长因子受体酪氨酸激酶抑制剂换药治疗的临床分析

目的 探讨表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)药物治疗肺癌患者致不良反应是否可以换用另外一种EGFR-TKI药物治疗,从而使患者能够继续从中获益.方法 回顾性总结接受过EGFR-TKI治疗的病例,筛选出因严重不良反应而换用另外一种EGFR-TKI药物的病例,分析疗效和安全性.从Pubmed中检索相关文献,进行文献总结分析.结果 共有4例患者因严重不良反应而换用另一种EGFR-TKI,其中男性4例,女性0例,中位年龄55岁(45~78岁).严重的不良反应包括肝毒性3例(4级2例、3级1例)、皮疹(过敏性紫癜)1例.药物转换从厄洛替尼换为埃克替尼1例,埃克替尼换为厄洛替尼2例,吉非替尼换为埃克替尼1例.更换药物后,未再出现类似严重不良反应.检索文献,共有13篇文献报道了54例因不良反应换用另一种EGFR-TKI治疗的病例,其中多数因肝毒性从吉非替尼换为厄洛替尼.结论 使用EGFR-TKI出现严重不良反应的肺癌患者,需要权衡换用另外一种EGFR-TKI的获益与风险.如获益大于风险,在严密的监测下,换用另外一种EGFR-TKI可能是一种可以选择的策略.但因病例数较少,尚需进一步收集病例,并研究其机制.

Switching of icotinib,erlotinib and gefitinib due to severe adverse effects

Objective To explore whether it is safe to try another epidermal growth factor receptor-tyrosine kinase in-hibitor (EGFR-TKI) for patients who experienced severe adverse effects during treatment so that they could benefit more from EGFR-TKIs. Method A retrospective review was conducted in medical records of patients who were given EGFR-TKIs. Patients who had switched to another EGFR-TKI due to severe adverse effects were included in the analysis, and the efficacy and safety were analyzed. Related literature were searched in Pubmed, and then were summarized. Result Four patients switched EGFR-TKIs due to severe adverse effects, and all were male, with a median age of 55 (45~78). Se-vere adverse effects included hepatotoxicity in 3 (grade Ⅳ in 2, grade Ⅲ in 1) and dermatologic toxicity in 1 (HSP). 1 had switched from erlotinib to icotinib, 2 from icotinib to erlotinib and 1 from gefitinib to icotinib. No severe adverse ef-fects recurred after any medication change. Thirteen literatures including 54 cases were eligible for analysis. Most pa-tients switched from gefitinib to erlotinib due to hepatotoxicity. Conclusion With careful monitoring, switching of ico-tinib, erlotinib and gefitinib is an alternative strategy for patients who have good response to EGFR-TKI, but more cases should be collected to establish robust evidence, and further researches are needed to clarify the mechanisms.