Kim Young Hak, Fukuhara Akiko, Mishima Michiaki
Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Case Rep Oncol. 2011 Sep;4(3):470-4. doi: 10.1159/000332758. Epub 2011 Sep 20.
Epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) is almost exclusively effective in patients with activating EGFR mutations, and median time to progression in such patients is generally up to 12 months. Usually, treatment with EGFR-TKI is terminated when disease progression is confirmed; however, acute exacerbation after the withdrawal of EGFR-TKI has been reported. In this paper, we report a case of a 35-year-old patient whose disease rapidly progressed after discontinuation of gefitinib and then rapidly regressed after reintroduction of gefitinib. In addition, we summarize the cases of 3 other patients who could be safely treated with continued erlotinib in combination with pemetrexed after disease progression. Currently, the mechanism of acquired resistance is intensively investigated and a number of new agents, such as irreversible EGFR inhibitors or MET inhibitors, are under development; however, they are still unavailable in clinical setting. We believe that continuing EGFR-TKI treatment after disease progression should be an option in patients who previously responded to EGFR-TKI under the present circumstances.
表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）几乎仅对具有EGFR激活突变的患者有效，这类患者的中位疾病进展时间通常可达12个月。通常，当确认疾病进展时会终止EGFR-TKI治疗；然而，已有报道称停用EGFR-TKI后会出现急性病情加重。在本文中，我们报告了1例35岁患者，其在停用吉非替尼后疾病迅速进展，而在重新使用吉非替尼后又迅速缓解。此外，我们总结了另外3例患者的病例，他们在疾病进展后继续使用厄洛替尼联合培美曲塞治疗可获得安全疗效。目前，对获得性耐药机制的研究正在深入进行，一些新型药物，如不可逆EGFR抑制剂或MET抑制剂，正在研发中；然而，在临床环境中仍无法使用。我们认为，在当前情况下，对于先前对EGFR-TKI有反应的患者，疾病进展后继续EGFR-TKI治疗应是一种选择。
