Yamanaka Yumie, Sekine Akimasa, Kato Terufumi, Yamakawa Hideaki, Ikeda Satoshi, Baba Tomohisa, Iwasawa Tae, Okudela Koji, Ogura Takashi
Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan.
Department of Respiratory Medicine, Tokyo Jikei University Hospital, Japan.
Intern Med. 2017 Nov 1;56(21):2895-2898. doi: 10.2169/internalmedicine.8638-16. Epub 2017 Sep 25.
We report an 80-year-old woman with EGFR-mutant lung adenocarcinoma with multiple brain metastases (BMs). All lesions including BM showed a successful resolution after initiating daily 150 mg erlotinib. However, a grade 2 bilirubin-increase developed, and it was necessary to reduce the dose of erlotinib to 50 mg every other day, which aggravated BM. Switching erlotinib to afatinib led to the resolution of BM without an increase in the bilirubin level. Our results indicate that afatinib is an important treatment option when erlotinib-induced hepatotoxicity develops, regardless of the patients' age. Particularly in those patients with BM, switching to afatinib may be preferable to reducing the dose of erlotinib.
我们报告了一名80岁的女性，患有表皮生长因子受体（EGFR）突变的肺腺癌并伴有多发脑转移（BMs）。在开始每日服用150毫克厄洛替尼后，包括脑转移灶在内的所有病灶均成功消退。然而，出现了2级胆红素升高，有必要将厄洛替尼剂量减至隔日50毫克，这使得脑转移灶病情加重。将厄洛替尼换为阿法替尼后，脑转移灶消退且胆红素水平未升高。我们的结果表明，当发生厄洛替尼诱导的肝毒性时，无论患者年龄如何，阿法替尼都是一种重要的治疗选择。特别是对于那些有脑转移的患者，换用阿法替尼可能比降低厄洛替尼剂量更为可取。
