Jung Patrick, Fortinsky Kyle J, Gallinger Zane R, Tartaro Piero
Department of Internal Medicine, University of Toronto, Toronto, ON, Canada; Division of Gastroenterology, University of Toronto, Toronto, ON, Canada.
Case Rep Gastrointest Med. 2016;2016:3562820. doi: 10.1155/2016/3562820. Epub 2016 Dec 8.
Previous case reports have described esophagitis thought to be secondary to crizotinib, an oral tyrosine-kinase inhibitor used in the treatment of anaplastic lymphoma kinase- (ALK-) positive non-small cell lung cancer (NSCLC). In those reports, the interval development of esophagitis was between two days and three months after initiating or reinitiating crizotinib therapy. We present a woman who developed ulcerative esophagitis ten months after beginning crizotinib therapy, which is highly unusual. We believe the provoking factor was a change in her medication administration routine, done to accommodate religious practices during the period of Ramadan. This case illustrates the mechanism of pill esophagitis and reinforces the importance of patient education when it comes to medication administration. Clinicians may consider early imaging or investigations in patients with concerning symptomatology in the context of crizotinib therapy or other offending medications. Future research may help to uncover additional risk factors for this exceedingly rare diagnosis in this patient population. Most importantly, this case highlights nonpharmacologic ways to improve tolerability and decrease adverse effects of a highly effective chemotherapeutic agent.
既往病例报告描述了被认为继发于克唑替尼的食管炎，克唑替尼是一种口服酪氨酸激酶抑制剂，用于治疗间变性淋巴瘤激酶（ALK）阳性非小细胞肺癌（NSCLC）。在那些报告中，食管炎的发生间隔为开始或重新开始克唑替尼治疗后的两天至三个月。我们报告了一名女性，她在开始克唑替尼治疗十个月后发生了溃疡性食管炎，这非常罕见。我们认为诱发因素是她为了适应斋月期间的宗教习俗而改变了用药常规。该病例说明了药丸性食管炎的机制，并强化了在药物给药方面对患者进行教育的重要性。临床医生在克唑替尼治疗或其他有害药物的背景下，对于有相关症状的患者可考虑早期影像学检查或进一步检查。未来的研究可能有助于发现该患者群体中这种极其罕见诊断的其他风险因素。最重要的是，该病例突出了改善耐受性和降低高效化疗药物不良反应的非药物方法。
