Kitajima Hiroko, Takahashi Hiroki, Harada Kazutoki, Kanai Akiko, Inomata Shin-Ichiro, Taniguchi Haruko, Saikai Toyohiro, Abe Shosaku
Third Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
Respirology. 2006 Mar;11(2):217-20. doi: 10.1111/j.1440-1843.2006.00835.x.
Gefitinib (ZD1839), a small-molecule epidermal growth factor receptor tyrosine kinase inhibitor, is an anticancer agent for patients with non-small cell lung carcinoma. Recently, however, as a result of accumulating evidence, it has been recognized that gefitinib can give rise to lethal lung toxicity. The authors report a case of interstitial lung disease (ILD) induced by gefitinib, which improved promptly following cessation of the administration of the agent. Clinical signs suggesting a good prognosis were noted, namely, findings similar to acute eosinophilic pneumonia on CT and a disassociation in the elevation of specific serum markers of ILD. At the time of onset of ILD, serum concentrations of surfactant protein (SP)-A and SP-D were significantly increased, whereas that of KL-6 was not increased. A previous study of three cases of lethal lung toxicity resulting from gefitinib administration revealed a significant and almost equal increase in KL-6, SP-A and SP-D. These results suggest that SP-A and SP-D may be indicators of gefitinib-induced ILD and that KL-6 is a predictor of outcome. Using a combination of these markers may help to establish a differential prognosis in patients with gefitinib-induced ILD.
吉非替尼（ZD1839）是一种小分子表皮生长因子受体酪氨酸激酶抑制剂，是用于非小细胞肺癌患者的抗癌药物。然而，最近由于证据不断积累，人们认识到吉非替尼可引发致命的肺毒性。作者报告了1例由吉非替尼引起的间质性肺病（ILD），在停用该药物后迅速改善。观察到提示预后良好的临床体征，即CT表现类似于急性嗜酸性粒细胞性肺炎，以及ILD特异性血清标志物升高出现分离。在ILD发病时，表面活性蛋白（SP）-A和SP-D的血清浓度显著升高，而KL-6的血清浓度未升高。先前一项关于3例因服用吉非替尼导致致命肺毒性的研究显示，KL-6、SP-A和SP-D显著且几乎等量增加。这些结果表明，SP-A和SP-D可能是吉非替尼诱导ILD的指标，而KL-6是预后的预测指标。联合使用这些标志物可能有助于对吉非替尼诱导ILD的患者建立鉴别预后。
