Brief Report: Chylothorax and Chylous Ascites During RET Tyrosine Kinase Inhibitor Therapy.
Brief Report: Chylothorax and Chylous Ascites During RET Tyrosine Kinase Inhibitor Therapy.
复制标题
DOI：
10.1016/j.jtho.2022.06.008
复制
发表时间：
2022-09
影响因子：
20.4
通讯作者：
Lin, Jessica J.
中科院分区：
文献类型：
--
作者：
Kalchiem-Dekel, Or;Falcon, Christina J.;Bestvina, Christine M.;Liu, Dazhi;Kaplanis, Lauren A.;Wilhelm, Clare;Eichholz, Jordan;Harada, Guilherme;Wirth, Lori J.;Digumarthy, Subba R.;Lee, Robert P.;Kadosh, David;Mendelsohn, Robin B.;Donington, Jessica;Gainor, Justin F.;Drilon, Alexander;Lin, Jessica J.
关键词：
自发性乳糜液很少见；然而，在接受RET酪氨酸激酶抑制剂(TKIs)治疗的患者中，独立研究人员观察到了这些现象。这项多中心的回顾性研究评估了接受RET TKI治疗的患者乳糜漏的频率。对乳糜性积液患者的临床病理特征和治疗进行了评估。对7,517名接受≥-1多激酶抑制剂/选择性RET-TKI治疗的泛癌患者和96名接受赛培卡替尼和/或普罗塞替尼治疗的选择性TKI患者进行了分析。塞培卡替尼最常见的是乳糜性渗出(7%)，其次是爱非非尼(4%)、卡波赞替尼(0.3%)和兰瓦替尼(0.02%)；普罗塞替尼没有观察到。12名患者有乳糜胸，5名患者有乳糜性腹水，5名患者两者都有。从TKI开始到确诊的时间为0.5~50个月。乳糜胸和乳糜性腹水的甘油三酯中位数分别为397 mg/dL和3786 mg/dL，差异有统计学意义(P=0.035)。恶性细胞出现在13%(3/22)的积液中。淋巴管造影术未发现乳糜漏。在初次引流后，76%的乳糜胸患者和80%的乳糜性腹水患者需要额外的干预。塞培卡替尼减药率为47%，乳糜液停用率为0%。从诊断到疾病进展的中位时间没有达到(95%CI：14.5-未定义)；从诊断到TKI停止的中位时间为11.4个月(95%CI：8.2-14.9)。在使用选定的RET TKI治疗期间，可能会出现乳糜性积液。认识到这一副作用是防止将恶化的积液误认为是进展性恶性肿瘤的关键。
Spontaneous chylous effusions are rare; however, they have been observed by independent investigators in patients treated with RET tyrosine kinase inhibitors (TKIs). This multicenter, retrospective study evaluated the frequency of chylous effusions in patients treated with RET TKIs. Clinicopathologic features and management of patients with chylous effusions were assessed. A pan-cancer cohort of 7,517 patients treated with ≥1 multikinase inhibitor (MKI)/selective RET TKI, and a selective TKI cohort of 96 patients treated with selpercatinib and/or pralsetinib, were analyzed. Chylous effusions were most common with selpercatinib (7%), followed by agerafenib (4%), cabozantinib (0.3%), and lenvatinib (0.02%); none were observed with pralsetinib. Twelve patients had chylothorax, five had chylous ascites, and five had both. Time from TKI initiation to diagnosis ranged from 0.5-50 months. Median fluid triglyceride level was lower in chylothoraces than chylous ascites [397 mg/dL (IQR: 304-4000) vs. 3,786 mg/dL (IQR: 842-6596), P=0.035]. Malignant cells were present in 13% (3/22) of effusions. Chyle leak was not identified via lymphangiography. Following initial drainage, 76% of patients with chylothorax and 80% with chylous ascites required additional interventions. Selpercatinib dose reduction and discontinuation rates chylous effusions were 47% and 0%, respectively. Median time from diagnosis to disease progression was not reached (95% CI: 14.5-undefined); median time from diagnosis to TKI discontinuation was 11.4 months (95% CI: 8.2-14.9). Chylous effusions can emerge during treatment with selected RET TKIs. Recognition of this side effect is key to prevent potential misattribution of worsening effusions to progressive malignancy.
登录
查看更多内容
DOI：
10.1056/nejmoa2005653
发表时间：
2020-08-27
期刊：
The New England journal of medicine
影响因子：
--
作者：
Drilon A;Oxnard GR;Tan DSW;Loong HHF;Johnson M;Gainor J;McCoach CE;Gautschi O;Besse B;Cho BC;Peled N;Weiss J;Kim YJ;Ohe Y;Nishio M;Park K;Patel J;Seto T;Sakamoto T;Rosen E;Shah MH;Barlesi F;Cassier PA;Bazhenova L;De Braud F;Garralda E;Velcheti V;Satouchi M;Ohashi K;Pennell NA;Reckamp KL;Dy GK;Wolf J;Solomon B;Falchook G;Ebata K;Nguyen M;Nair B;Zhu EY;Yang L;Huang X;Olek E;Rothenberg SM;Goto K;Subbiah V
通讯作者：
Subbiah V
影响因子：
44.5
作者：
Subbiah, Vivek;Hu, Mimi, I;Taylor, Matthew H.
通讯作者：
Taylor, Matthew H.
DOI：
10.1093/annonc/mdy137
发表时间：
2018-08-01
期刊：
Annals of oncology : official journal of the European Society for Medical Oncology
影响因子：
--
作者：
Subbiah V;Velcheti V;Tuch BB;Ebata K;Busaidy NL;Cabanillas ME;Wirth LJ;Stock S;Smith S;Lauriault V;Corsi-Travali S;Henry D;Burkard M;Hamor R;Bouhana K;Winski S;Wallace RD;Hartley D;Rhodes S;Reddy M;Brandhuber BJ;Andrews S;Rothenberg SM;Drilon A
通讯作者：
Drilon A
影响因子：
51.1
作者：
Gainor, Justin F.;Curigliano, Giuseppe;Subbiah, Vivek
通讯作者：
Subbiah, Vivek
影响因子：
158.5
作者：
Wirth, L. J.;Sherman, E.;Cabanillas, M. E.
通讯作者：
Cabanillas, M. E.