厄洛替尼致肝损害

1例表皮生长因子受体阳性的初诊78岁男性肺癌患者接受厄洛替尼150mg，1次／d口服化疗。化疗前丙氨酸转氨酶（ALT）12U／L，天冬氨酸转氨酶（AST）16U／L，总胆红素（TBil）22．0μmol／L，直接胆红素（DBil）7．6μmol／L。化疗2周复查：ALT30U／L，AST33U／L，TBil20．0μmol／L，DBil6．3μmol／L。化疗2个月患者出现尿色加深，全身皮肤及巩膜黄染。化疗约75d实验窄检查：ALT368U／L，TBil182．1μmol／L，DBil155．2μmol／L。停用厄洛替尼，予保肝治疗。停药第4天，ALT171U／L，AST177U／L，TBil322．0μmol／L，DBil278．2μmol／L。停药第6天，加用甲泼尼尼。停约第12火，AUF132U／L，AST141U／L，TBil172．6μmol／L，DBil135．4μmol／L。停用厄洛替尼2个月，ALT12U／L，AST30U／L，TBil19．8μmol／L，DBil13．5μnol／L。随后换用吉西他滨联合尼妥珠单抗继续化疗6个疗程，未再出现肝功能异常。

Liver damage due to erlotinib

A 78-year-old man, who was newly diagnosed with epidermal growth factor receptor- received treatment with oral erlotinib 150 mg once daily. Laboratory test before the chemotherapy showed the following values ： alanine aminotransferase （ ALT ） 12 U/L, asp＇mate aminotransferase （AST） 16 U/L, total bilirubin （TBil） 22.0μmol/L, direct bilirubin （DBil） 7.6μmol/L. Two weeks after chemotherapy treatment, re-examination revealed the following values： ALT 30 U/L, AST 33 U/L, TBil 20.0μmol/L, DBil 6.3μmol/L. Two months after chemotherapy, the patient presented with dark urine and yellowish whole skin and sclera. Seventy-five days after the chemotherapy, laboratory test showed the following values： ALT 368 U/L, TBil 182. 1μmol/L, DBil 155. 2 μmol/L. Erlotinib was discontinued and liver-protective treatment was given. On day 4 after erlotinib discontinuation, the levels of ALT, AST, TBil, and DBil were 171 U/L, 177 U/L, 322.0μmol/L, and 278.2μmol/L, respectively. On day 6 after erlotinib discontinuation, methylprednisolone was added to his regimen. On day 12 after erlotinib discontinuation, the levels of ALT, AST, TBil, and DBil were 132 U/L, 141 U/L, 172.6μmoL/L, 135.4 p, mol/l,, respectively. Two months after erlotinib discontinuation, the levels of ALT, AST, TBil, and DBil were 12 U/L, 30 U/L, 19. 8μmol/L, and 13.5 μmol/L, respectively. Then chemotherapy was switched to 6 cycles of gemcitabine and nimotuzumab and abnormal liver function did not recur.