Systemic steroid treatment can desensitize the skin reaction due to regorafenib in a recurrence colorectal cancer patient
Systemic steroid treatment can desensitize the skin reaction due to regorafenib in a recurrence colorectal cancer patient
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DOI：
10.1007/s13691-019-00376-4
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发表时间：
2019-10-01
影响因子：
0.7
通讯作者：
Ueno, Hideki
中科院分区：
文献类型：
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作者：
Tashiro, Keita;Shinto, Eiji;Ueno, Hideki
口服瑞格非尼已被证明对标准治疗进展的转移性结直肠癌患者具有生存益处。然而，由于副作用，患者有时不能继续使用瑞戈非尼治疗。目前，还没有确定的支持性治疗，可以进行，以帮助在这些有问题的条件下继续服用瑞格非尼。我们报告的情况下，59岁的日本妇女诊断为乙状结肠癌（T3 N2 aM 0，IIIC期）根治性手术后复发。尽管接受了多线标准化疗，但仍无法维持疾病控制。因此，瑞戈非尼开始作为晚期治疗。然而，2周后，患者发生瑞戈非尼诱导的严重多形性红斑;因此，停用瑞戈非尼，并开始口服泼尼松龙。当不良反应消退并停用泼尼松龙时，重新开始给予瑞戈非尼，但皮疹迅速再次出现。重新引入泼尼松龙治疗，治愈了皮疹;因此，在第三次尝试给予瑞格非尼后，继续给予泼尼松龙。在泼尼松龙给药下，皮疹没有复发，患者共接受了13个疗程的瑞格非尼治疗。此外，在瑞戈非尼治疗结束时开始重新生长的转移性病灶对亚叶酸、氟尿嘧啶和伊立替康联合帕尼单抗的再激发化疗显示出良好的反应。治疗顺序可能对患者接受瑞戈非尼治疗后30个月的长期生存产生了积极影响。全身给予类固醇被认为是一种有前途的选择，可作为重度皮疹患者持续瑞戈非尼治疗的支持性治疗。
Oral intake of regorafenib has been shown to have survival benefits in patients with metastatic colorectal cancer progressing on standard therapies. However, because of adverse effects, the patients sometimes cannot continue treatment with regorafenib. Currently, there is no established supportive therapy that can be performed to aid in continuing regorafenib intake under these problematic conditions. We report the case of a 59-year-old Japanese woman diagnosed with recurrence after curative operation for sigmoid colon cancer (T3N2aM0, Stage IIIC). Despite undergoing multiple lines of standard chemotherapy, disease control could not be maintained. Consequently, regorafenib was started as a late-line treatment. However, after 2 weeks, the patient experienced regorafenib-induced serious erythema multiforme; thus, regorafenib was discontinued and oral prednisolone was started. Regorafenib administration was resumed when the adverse effects resolved and prednisolone was stopped, but skin rash rapidly reappeared. Prednisolone treatment was reintroduced, which cured the rash; thus, after the third attempt to administer regorafenib, prednisolone was continuously administered. There was no relapse of the rash under prednisolone administration, and the patient received a total of 13 courses of regorafenib. Moreover, the metastatic lesions that had started to regrow at the end of the regorafenib therapy showed good response to the rechallenge chemotherapy of folinic acid, fluorouracil, and irinotecan therapy with panitumumab. The sequence of therapies possibly had a positive impact on the patient's long survival of 30 months after the regorafenib treatment. Systemic administration of steroid is considered as a promising option as a supportive therapy for continuing regorafenib treatment in patients experiencing a severe skin rash.