Tao Gabriel, Chityala Pavan Kumar
Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, TX 77204, USA.
Toxicol Res (Camb). 2021 May 3;10(3):476-486. doi: 10.1093/toxres/tfab026. eCollection 2021 May.
The epidermal growth factor receptor (EGFR) family is a class of receptor tyrosine kinase playing a central role in carcinogenesis and cancer progression. The members of this family, particularly EGFR and human epidermal growth factor receptor 2 (HER2), are the most extensively studied drug targets for malignancy. Today, numerous tyrosine kinase inhibitors targeting EGFR family have been developed to combat non-small-cell lung cancer and breast cancer. However, severe gastrointestinal (GI) toxicity leading to dose reduction and treatment discontinuation hampers the therapeutic outcome of EGFR inhibitors. Diarrhea is one of the most frequent GI side effects, especially when it comes to second-generation EGFR inhibitors. Enterocytes apoptosis and increased inflammation accompany with many oral EGFR inhibitors. Loperamide and budesonide are the first-line treatment to manage such adverse effects. However, current prophylaxis and management are all empirical interventions to relieve the symptom. They do not specifically target the toxicological mechanism of EGFR inhibitors. Hereby, those anti-diarrhea agents do not work well when used in cancer patients experiencing EGFR inhibitor-induced diarrhea. On the other hand, the toxicological mechanism of EGFR inhibitor-induced diarrhea is poorly understood. Thus, determining the mechanism behind such diarrhea is urgently in need for developing genuinely effective anti-diarrhea agents. This review aims to call attention to EGFR inhibitor-induced diarrhea, a highly occurring and devastating cancer drug toxicity.
表皮生长因子受体(EGFR)家族是一类受体酪氨酸激酶,在癌症发生和发展过程中起着核心作用。该家族成员,特别是EGFR和人表皮生长因子受体2(HER2),是针对恶性肿瘤研究最为广泛的药物靶点。如今,已开发出众多靶向EGFR家族的酪氨酸激酶抑制剂来对抗非小细胞肺癌和乳腺癌。然而,导致剂量减少和治疗中断的严重胃肠道(GI)毒性阻碍了EGFR抑制剂的治疗效果。腹泻是最常见的胃肠道副作用之一,尤其是对于第二代EGFR抑制剂而言。许多口服EGFR抑制剂会伴随肠上皮细胞凋亡和炎症增加。洛哌丁胺和布地奈德是治疗此类不良反应的一线药物。然而,目前的预防和治疗措施均为缓解症状的经验性干预手段。它们并未特异性针对EGFR抑制剂的毒理学机制。因此,这些止泻药物在用于经历EGFR抑制剂诱导腹泻的癌症患者时效果不佳。另一方面,EGFR抑制剂诱导腹泻的毒理学机制尚不清楚。因此,迫切需要确定此类腹泻背后的机制,以开发真正有效的止泻药物。本综述旨在引起人们对EGFR抑制剂诱导腹泻的关注,这是一种高发且具有破坏性的癌症药物毒性。