Department of Hematology-Oncology, Chonnam National University Medical School, Gwangju 501-757, South Korea.
BMC Cancer. 2010 Aug 18;10:438. doi: 10.1186/1471-2407-10-438.
Imatinib mesylate has been used for the treatment of unresectable or metastatic gastrointestinal stromal tumors (GIST). The current recommended dose of imatinib is 400 mg/day that is increased to 800 mg/day in cases with disease progression. However, imatinib can be associated with diverse adverse events, which has limited its use. We report a case of severe adverse skin reactions with neutropenic fever during imatinib treatment in a patient with GIST.
A 71-year-old man was admitted with a one month history of epigastric pain and a palpable mass in the right upper quadrant. An abdominal CT scan revealed a 20 x 19 cm intraabdominal mass with tumor invasion into the peritoneum. Needle biopsy was performed and the results showed spindle shaped tumor cells that were positive for c-KIT. The patient was diagnosed with unresectable GIST. Imatinib 400 mg/day was started. The patient tolerated the first eight weeks of treatment. However, about three months later, the patient developed a grade 4 febrile neutropenia and a grade 3 exfoliative skin rash. The patient recovered from this serious adverse events after discontinuation of imatinib with supportive care. However, the skin lesions recurred whenever the patient received imatinib over 100 mg/day. Therefore, imatinib 100 mg/day was maintained. Despite the low dose imatinib, follow up CT showed a marked partial response without grade 3 or 4 toxicities.
The recommended dose of imatinib for the treatment of GIST is 400 mg/day but patients at risk for adverse drug reaction may benefit from lower doses. Individualized treatment is needed for such patients, and we may also try sunitinib as a alternative drug.
甲磺酸伊马替尼已被用于治疗不可切除或转移性胃肠道间质瘤（GIST）。目前推荐的伊马替尼剂量为 400mg/天，疾病进展时增加至 800mg/天。然而，伊马替尼可能会引起多种不良反应，从而限制了其应用。我们报告了一例 GIST 患者在伊马替尼治疗期间出现严重皮肤不良反应和中性粒细胞减少性发热的病例。
一名 71 岁男性因上腹痛和右上象限可触及肿块一个月入院。腹部 CT 扫描显示 20×19cm 大小的腹腔内肿块，肿瘤侵犯腹膜。进行了针吸活检，结果显示梭形肿瘤细胞 c-KIT 阳性。患者被诊断为不可切除的 GIST。开始给予伊马替尼 400mg/天。患者在前 8 周的治疗中耐受良好。然而，大约 3 个月后，患者出现了 4 级发热性中性粒细胞减少和 3 级剥脱性皮炎。在停用伊马替尼并给予支持治疗后，患者从这些严重的不良反应中恢复。然而，每当患者接受超过 100mg/天的伊马替尼治疗时，皮肤病变都会复发。因此，维持伊马替尼 100mg/天。尽管剂量较低，但随访 CT 显示部分缓解明显，无 3 或 4 级毒性。
伊马替尼治疗 GIST 的推荐剂量为 400mg/天，但有发生药物不良反应风险的患者可能从低剂量中获益。对于这些患者需要个体化治疗，我们也可以尝试舒尼替尼作为替代药物。
