Eshuis Marga, Ahsmann Els J M, van Egmond N H
Groene Hart Ziekenhuis, Gouda.
Ned Tijdschr Geneeskd. 2013;157(7):A5519.
Erlotinib is used to treat patients with non-small cell lung cancer (NSCLC). The use of this tyrosine kinase inhibitor can result in interstitial lung disease, but the aetiology of this phenomenon is not clear.
A 68-year-old man with NSCLC, who had been undergoing treatment with erlotinib (150 mg daily) for the previous two weeks, presented with dyspnoea. A chest x-ray revealed infiltrates for which we started broad-spectrum antibiotics, high dose glucocorticoids and oxygen supplementation; erlotinib was discontinued. Despite these measures, the patient died of respiratory failure. Autopsy showed diffuse alveolar damage; the blood cultures taken while the patient was still alive and the post-mortem lung cultures were negative. The alveolar damage was possibly a consequence of the use of erlotinib.
Clinicians should be alert to worsening pulmonary symptoms without signs of infection in patients using erlotinib. Discontinuation of erlotinib and glucocorticoid treatment should be considered until alveolar damage caused by the use of erlotinib can be excluded.
厄洛替尼用于治疗非小细胞肺癌（NSCLC）患者。这种酪氨酸激酶抑制剂的使用可导致间质性肺疾病，但该现象的病因尚不清楚。
一名68岁的NSCLC男性患者，此前两周一直在接受厄洛替尼（每日150毫克）治疗，出现呼吸困难。胸部X线检查显示有浸润影，为此我们开始使用广谱抗生素、高剂量糖皮质激素并给予吸氧；停用了厄洛替尼。尽管采取了这些措施，患者仍死于呼吸衰竭。尸检显示弥漫性肺泡损伤；患者生前采集的血培养及死后肺组织培养均为阴性。肺泡损伤可能是使用厄洛替尼的结果。
临床医生应警惕使用厄洛替尼的患者出现无感染迹象的肺部症状恶化情况。在排除厄洛替尼所致肺泡损伤之前，应考虑停用厄洛替尼并进行糖皮质激素治疗。
