Yamaguchi Teppei, Gotoh Yusuke, Hattori Hidekazu, Katsuno Hidetoshi, Imaizumi Kazuyoshi
Department of Respiratory Medicine, Fujita Health University, Toyoake, Aichi 470-1192, Japan.
Department of Radiology, Fujita Health University, Toyoake, Aichi 470-1192, Japan.
Oncol Lett. 2018 Jul;16(1):1046-1050. doi: 10.3892/ol.2018.8708. Epub 2018 May 14.
A previous randomized phase II study in patients with non-small cell lung cancer (NSCLC) identified that combination treatment with erlotinib plus bevacizumab prolonged progression-free survival compared with erlotinib alone. However, combination bevacizumab and erlotinib treatment generally increased the risk of severe adverse events, including hemorrhage, thrombosis, fistula formation and gastrointestinal perforation. The present report describes two patients with NSCLC harboring epidermal growth factor receptor (EGFR) mutations, who experienced gastrointestinal perforation associated with erlotinib plus bevacizumab combination therapy. The first patient, a 67-year-old male with stage IIIB lung adenocarcinoma harboring a L858R point mutation in EGFR exon 21, received concurrent chemoradiotherapy. However, seven months later, the patient experienced a relapse and was administered erlotinib plus bevacizumab treatment. A total of two months subsequent to commencing treatment, the patient developed a perforated duodenal ulcer. The second patient, a 66-year-old male with lung adenocarcinoma harboring a deletion in EGFR exon 19 and multiple pulmonary metastases, demonstrated a partial response to erlotinib plus bevacizumab treatment. A total of seven months subsequent to starting treatment, the patient experienced lower abdominal pain, and abdominal computed tomography confirmed a diagnosis of colocutaneous fistula complicating sigmoid diverticulitis. Following repair of the perforation, both patients were restarted on erlotinib treatment alone. Gastrointestinal perforation may be a potentially severe adverse event of erlotinib plus bevacizumab combination therapy, even in the absence of tumor metastasis in the abdomen.
先前一项针对非小细胞肺癌（NSCLC）患者的随机II期研究发现，与单独使用厄洛替尼相比，厄洛替尼联合贝伐单抗治疗可延长无进展生存期。然而，贝伐单抗与厄洛替尼联合治疗通常会增加严重不良事件的风险，包括出血、血栓形成、瘘管形成和胃肠道穿孔。本报告描述了两名患有表皮生长因子受体（EGFR）突变的NSCLC患者，他们在接受厄洛替尼联合贝伐单抗治疗时发生了胃肠道穿孔。第一名患者是一名67岁男性，患有IIIB期肺腺癌，EGFR外显子21存在L858R点突变，接受了同步放化疗。然而，七个月后，患者病情复发，接受了厄洛替尼联合贝伐单抗治疗。开始治疗两个月后，患者出现十二指肠溃疡穿孔。第二名患者是一名66岁男性，患有肺腺癌，EGFR外显子19缺失并伴有多处肺转移，对厄洛替尼联合贝伐单抗治疗有部分反应。开始治疗七个月后，患者出现下腹部疼痛，腹部计算机断层扫描确诊为乙状结肠憩室炎并发结肠皮肤瘘。穿孔修复后，两名患者均重新开始单独使用厄洛替尼治疗。即使在腹部没有肿瘤转移的情况下，胃肠道穿孔也可能是厄洛替尼联合贝伐单抗治疗的潜在严重不良事件。
