Division of Allergy, Immune and Respiratory System, Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul, Republic of Korea.
Nowonkyunghee korean medical clinic, 1363, Dongil-ro, Nowon-gu, Seoul, Korea.
Medicine (Baltimore). 2021 Feb 5;100(5):e24292. doi: 10.1097/MD.0000000000024292.
Gefitinib is a first-line palliative chemotherapy drug used to treat advanced non-small-cell lung cancer (NSCLC) in patients who have an epidermal growth factor receptor (EGFR) mutation. However, approximately two-thirds of NSCLC patients with EGFR-tyrosine kinase inhibitor experience dermatological toxicity. Cutaneous toxicity is usually not life threatening but can necessitate modification or discontinuation of medication in severe cases. In this case, despite a reduction in the dose of gefitinib due to side effects, combined treatment with modified Bojungikki-tang (BJKIT) increased progression-free survival (PFS) in an advanced NSCLC patient.
An 83-year-old Asian woman presented with chief complaints of chronic cough, dyspnea, weight loss, and anorexia.
The patient was diagnosed with stage IV NSCLC (T2aN3M1), adenocarcinoma with metastasis to the lymph node, brain, and bone based on image scan and biopsy. An EGFR deletion was detected in exon 19.
The patient was treated with gefitinib (250 mg/d) and traditional herbal medicine, modified Bojungikki-tang (BJIKT). However, after 1 year of combination therapy, gefitinib was tapered down to once per week while modified BJIKT was maintained.
A partial response was achieved, but after 3 months severe papulopustular skin rashes developed and became aggravated with time. Thus, the gefitinib dose was reduced. However, the PFS has been maintained for approximately 78 months.
Despite the reduction in gefitinib dose due to side effects, the combined treatment of gefitinib and the modified BJIKT has maintained a PFS of over 78 months, indicating that modified BJIKT enhanced the anti-cancer effect of gefitinib in a patient with advanced NSCLC harboring the EFGR mutation, and may have delayed acquired resistance, the main limitation on the efficacy of gefitinib. Further investigations including clinical trials are needed to confirm these effects.
吉非替尼是一种用于治疗表皮生长因子受体（EGFR）突变的晚期非小细胞肺癌（NSCLC）患者的一线姑息化疗药物。然而，大约三分之二的接受 EGFR 酪氨酸激酶抑制剂治疗的 NSCLC 患者会出现皮肤毒性。皮肤毒性通常不会危及生命，但在严重的情况下可能需要修改或停止用药。在这种情况下，尽管由于副作用而减少了吉非替尼的剂量，但在晚期 NSCLC 患者中，联合使用改良补中益气汤（Bojungikki-tang，BJKIT）可提高无进展生存期（progression-free survival，PFS）。
一位 83 岁的亚洲女性因慢性咳嗽、呼吸困难、体重减轻和厌食就诊。
根据影像学扫描和活检结果，患者被诊断为 IV 期 NSCLC（T2aN3M1），腺癌伴淋巴结、脑和骨转移。在第 19 外显子检测到 EGFR 缺失。
患者接受吉非替尼（250mg/d）和传统草药改良补中益气汤（BJKIT）治疗。然而，在联合治疗 1 年后，吉非替尼的剂量减少至每周一次，同时维持改良 BJKIT 的治疗。
达到部分缓解，但 3 个月后出现严重的丘疹脓疱性皮疹，并随着时间的推移逐渐加重。因此，吉非替尼的剂量减少。然而，PFS 已维持约 78 个月。
尽管由于副作用减少了吉非替尼的剂量，但吉非替尼联合改良 BJKIT 的治疗维持了超过 78 个月的 PFS，表明改良 BJKIT 增强了携带 EGFR 突变的晚期 NSCLC 患者中吉非替尼的抗癌作用，并可能延迟了获得性耐药，这是吉非替尼疗效的主要限制。需要进一步的研究，包括临床试验，以证实这些效果。
