Rittberg Rebekah, Ho Cheryl, Wang Ying
Medical Oncology, BC Cancer, Vancouver, CAN.
Medicine, The University of British Columbia, Vancouver, CAN.
Cureus. 2022 Apr 26;14(4):e24513. doi: 10.7759/cureus.24513. eCollection 2022 Apr.
Osimertinib is a third-generation irreversible epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor currently used as first-line systemic therapy for advanced EGFR mutant non-small cell lung cancer. Osimertinib is generally very well tolerated with only a 1% risk of grade 3-4 skin toxicity. Here we present a case of a 68-year-old Asian male with advanced EGFR exon 19 deletion non-small cell lung cancer. After initiation of osimertinib 80 mg daily, he had a rapid worsening of his pre-existing scaly psoriatic plaques with desquamation. Treatment was withheld while psoriasis therapy was administered. He was rechallenged on osimertinib 40 mg daily and within three days developed fever, tachycardia and widespread skin desquamation. There was an initial concern of toxic epidermal necrolysis; however, this was ultimately determined to be a severe flare of psoriasis. This case serves as a reminder that severe and potentially life-threatening complications can occur, and it is imperative to maintain a high level of vigilance for unusual toxicities of EGFR tyrosine kinase inhibitors, including Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis or psoriasis.
奥希替尼是一种第三代不可逆表皮生长因子受体（EGFR）酪氨酸激酶抑制剂，目前用作晚期EGFR突变型非小细胞肺癌的一线全身治疗药物。奥希替尼一般耐受性良好，3-4级皮肤毒性风险仅为1%。在此，我们报告一例68岁亚洲男性晚期EGFR外显子19缺失型非小细胞肺癌病例。在开始每日服用80毫克奥希替尼后，他原有的鳞屑性银屑病斑块迅速恶化并出现脱屑。在给予银屑病治疗的同时停用了奥希替尼。之后他再次接受每日40毫克奥希替尼治疗，三天内出现发热、心动过速和广泛的皮肤脱屑。最初怀疑是中毒性表皮坏死松解症；然而，最终确定这是银屑病的严重发作。该病例提醒我们，可能会发生严重且可能危及生命的并发症，对于EGFR酪氨酸激酶抑制剂的异常毒性，包括史蒂文斯-约翰逊综合征（SJS）、中毒性表皮坏死松解症或银屑病，必须保持高度警惕。
