Rechallenge with gefitinib following severe drug-induced hepatotoxicity in a patient with advanced non-small cell lung cancer: A case report and literature review.
Rechallenge with gefitinib following severe drug-induced hepatotoxicity in a patient with advanced non-small cell lung cancer: A case report and literature review.
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DOI：
10.3892/ol.2013.1756
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发表时间：
2014-03
期刊：
影响因子：
2.9
通讯作者：
Ma S
中科院分区：
文献类型：
--
作者：
Chen X;Pan Y;Zhang S;Chen D;Yang S;Li X;Ma S
吉非替尼已成为亚洲晚期非小细胞肺癌（NSCLC）患者中最广泛使用的表皮生长因子受体酪氨酸激酶抑制剂。常见的副作用包括轻度至中度皮疹和腹泻，然而，在长期服用吉非替尼时，药物引起的不同严重程度的肝损伤被忽视，很少报告。本病例报告介绍了一例中国女性NSCLC患者，该患者发生了重度吉非替尼诱导的肝毒性，并在停药3个月后再次接受吉非替尼治疗。该患者获得部分临床缓解，但在吉非替尼给药14个月后发生了药物诱导的4级肝毒性。作为替代方案，给予4个周期的化疗以控制肿瘤进展。在患者肝功能恢复后，吉非替尼与积极的保肝治疗一起重新激发。患者表现出良好的疾病控制，并维持正常肝功能>6个月。因此，序贯化疗和吉非替尼再激发与保肝治疗可能是一个潜在的新的治疗策略，吉非替尼诱导的肝毒性。
Gefitinib has come to be the most widely used epidermal growth factor receptor-tyrosine kinase inhibitor in the treatment of advanced non-small cell lung cancer (NSCLC) in Asian patients. Common side effects include mild to moderate skin rash and diarrhea, however, drug-induced liver injury of varying severity is overlooked in long-term gefitinib administration and rarely reported. The current case report presents a female Chinese NSCLC patient who developed severe gefitinib-induced hepatotoxicity and was rechallenged with gefitinib following a 3-month break. The patient achieved partial clinical remission but developed drug-induced grade 4 hepatotoxicity following gefitinib administration for 14 months. As an alternative, 4 cycles of chemotherapy were administered to control tumor progression. Following restoration of the patient’s liver function, gefitinib was rechallenged together with active hepatoprotective therapy. The patient presented good disease control and maintained normal liver function for >6 months. Thus, sequential chemotherapy and gefitinib rechallenge with hepatoprotective therapy may be a potential new treatment strategy for gefitinib-induced hepatotoxicity.
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