Ferro Alessandra, Filoni Angela, Pavan Alberto, Pasello Giulia, Guarneri Valentina, Conte PierFranco, Alaibac Mauro, Bonanno Laura
Department of Surgery, Oncology and Gastroenterology, Università degli Studi di Padova, Padova, Italy.
Medical Oncology 2, Istituto Oncologico Veneto Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy.
Front Med (Lausanne). 2021 Jun 4;8:570921. doi: 10.3389/fmed.2021.570921. eCollection 2021.
EGFR tyrosine kinase inhibitors (TKIs) are the front-line treatment in mutation positive advanced non-small cell lung cancer (aNSCLC) patients. Generally, they are well-tolerated but skin toxicity is common (45-100% of patients) and may adversely affect quality of life. Pathogenesis of cutaneous side effects is usually linked to EGFR expression in normal cells of the epidermis and not immune-related. Subacute cutaneous lupus erythematosus (SCLE) is an autoimmune disease and about 40% of SCLE cases are drug related, but no reports are available involving osimertinib. Our report depicts a drug induced-SCLE (DI-SCLE) caused by erlotinib and worsened by osimertinib. The adverse event is characterized by the absence of systemic symptoms. Diagnosis has been performed by skin biopsy and the conditions improved with systemic steroids administration and EGFR-TKIs discontinuation. The report underlines the importance of a complete dermatologic diagnosis of skin lesions induced by EGFR inhibitors, according to symptom severity and timing of improving with standard clinical management. The diagnosis of immune-related skin toxicity in this context affects the treatment and the outcome of skin toxicity and must be taken into account when planning subsequent treatments, potentially including immune checkpoint inhibitors (ICIs).
表皮生长因子受体酪氨酸激酶抑制剂（TKIs）是表皮生长因子受体突变阳性的晚期非小细胞肺癌（aNSCLC）患者的一线治疗药物。一般来说，它们耐受性良好，但皮肤毒性很常见（45%-100%的患者），可能会对生活质量产生不利影响。皮肤副作用的发病机制通常与表皮正常细胞中的表皮生长因子受体表达有关，而非免疫相关。亚急性皮肤型红斑狼疮（SCLE）是一种自身免疫性疾病，约40%的SCLE病例与药物有关，但尚无关于奥希替尼的相关报道。我们的报告描述了一例由厄洛替尼引起、并因奥希替尼而加重的药物性亚急性皮肤型红斑狼疮（DI-SCLE）。该不良事件的特点是无全身症状。通过皮肤活检进行诊断，并通过全身使用类固醇和停用表皮生长因子受体酪氨酸激酶抑制剂后病情改善。该报告强调了根据症状严重程度和标准临床管理改善时间，对表皮生长因子受体抑制剂引起的皮肤病变进行全面皮肤科诊断的重要性。在这种情况下，免疫相关皮肤毒性的诊断会影响皮肤毒性的治疗和结果，在规划后续治疗时必须予以考虑，后续治疗可能包括免疫检查点抑制剂（ICIs）。
