Clinical Analysis of Erlotinib-induced Severe Rash and Fatal Interstitial Lung Disease: A Case Report and Literature Review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

ZongXiaofu ¹ , XieLinyan ² , LuJiao ² , WangHui ¹ , LiTian ³ , HuangMao ² ,  ZhouLinfu ²

1. Department of Respiratory Medicine, The 81^st Hospital of Chinese PLA, Nanjing, Jiangsu, 210002, China;
2. ;
3. ;

Corresponding author：

ZhouLinfu, Email: lfzhou@njmu.edu.cn

Keywords：

Erlotinib; Severe rash; Fatal interstitial lung disease; Non-small cell lung cancer

DOI：

10.7507/1671-6205.2014066

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Objective To improve the knowledge of erlotinib-induced severe rash and fatal interstitial lung disease (ILD). Methods The clinical feature and radiology of erlotinib-associated severe rash and fatal ILD were analyzed in one patient with advanced non-small cell lung cancer (NSCLC) in the 81^st Hospital of Chinese PLA,and the related literatures were reviewed. Results The patient was a 78-year-old male non-smoker with stage Ⅳ right lower lobe squamous cell carcinoma,and his epidermal growth factor receptor gene showed mutation at exon 21.He had a history of chronic obstructive pulmonary disease and mild pulmonary fibrosis.Following one cycle of chemotherapy with gemcitabine plus cisplatin,he received erlotinib 150 mg daily.After 40 days of targeting therapy,the size of the lung cancer was decreased significantly concomitant with severe rash.Again,severe rash and fatal ILD appeared after using erlotinib 100 mg daily for 4 days and 50 mg daily for 2 days,respectively.The tumor progressed markedly although both rash and ILD were almost abolished following withdrawal of erlotinib as well as empirical impact of glucocorticoid and sequential therapy. Conclusion Physicians should be alerted to the possibility of erlotinib-induced severe rash and fatal ILD.Those with pathologic findings of usual interstitial pneumonia on resected lung specimens or known pulmonary fibrosis may be at particular risk for erlotinib-related pulmonary toxicity.

Citation： ZongXiaofu, XieLinyan, LuJiao, WangHui, LiTian, HuangMao, ZhouLinfu. Clinical Analysis of Erlotinib-induced Severe Rash and Fatal Interstitial Lung Disease: A Case Report and Literature Review. Chinese Journal of Respiratory and Critical Care Medicine, 2014, 13(3): 273-276. doi: 10.7507/1671-6205.2014066 Copy

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4.	崔迪,崔俊昌,陈良安,等.厄洛替尼单药治疗非小细胞肺癌继发重症肺纤维化一例.中华内科杂志,2008,47:151.
5.	Hata A,Katakami N,Kunimasa K,et al.Erlotinib for pretreated squamous cell carcinoma of the lung in Japanese patients.Jpn J Clin Oncol,2011,41:1366-1372.
6.	Boeck S,Hausmann A,Reibke R,et al.Severe lung and skin toxicity during treatment with gemcitabine and erlotinib for metastatic pancreatic cancer.Anti-Cancer Drugs,2007,18:1109-1111.
7.	Ren S,Li Y,Li W,et al.Fatal asymmetric interstitial lung disease after erlotinib for lung cancer.Respiration,2012,84:431-435.
8.	Lind JS,Smit EF,Grünberg K,et al.Fatal interstitial lung disease after erlotinib for non-small cell lung cancer.J Thorac Oncol,2008,3:1050-1053.
9.	Zhou LF,Zhang SJ,Shao YF,et al.A unique life-threatening mediastinal liposarcoma mimicking pleural effusion.Am J Respir Crit Care Med,2012,186:106.
10.	Yang ZY,Yuan JQ,Di MY,et al.Gemcitabine plus erlotinib for advanced pancreatic cancer:A systemic review with meta-analysis.PLoS ONE,2013;8:e57528.

1. Liu V,White DA,Zakowski MF,et al.Pulmonary toxicity associated with erlotinib.Chest,2007,132:1042-1044.
2. 吴晓虹,胡蕙蕙,周畔,等.使用厄洛替尼治疗肺癌后睫毛异常生长一例.中华结核和呼吸杂志,2012,35:145-146.
3. Makris D,Scherpereel A,Copin MC,et al.Fatal interstitial lung disease associated with oral erlotinib therapy for lung cancer.BMC Cancer,2007,7:150.
4. 崔迪,崔俊昌,陈良安,等.厄洛替尼单药治疗非小细胞肺癌继发重症肺纤维化一例.中华内科杂志,2008,47:151.
5. Hata A,Katakami N,Kunimasa K,et al.Erlotinib for pretreated squamous cell carcinoma of the lung in Japanese patients.Jpn J Clin Oncol,2011,41:1366-1372.
6. Boeck S,Hausmann A,Reibke R,et al.Severe lung and skin toxicity during treatment with gemcitabine and erlotinib for metastatic pancreatic cancer.Anti-Cancer Drugs,2007,18:1109-1111.
7. Ren S,Li Y,Li W,et al.Fatal asymmetric interstitial lung disease after erlotinib for lung cancer.Respiration,2012,84:431-435.
8. Lind JS,Smit EF,Grünberg K,et al.Fatal interstitial lung disease after erlotinib for non-small cell lung cancer.J Thorac Oncol,2008,3:1050-1053.
9. Zhou LF,Zhang SJ,Shao YF,et al.A unique life-threatening mediastinal liposarcoma mimicking pleural effusion.Am J Respir Crit Care Med,2012,186:106.
10. Yang ZY,Yuan JQ,Di MY,et al.Gemcitabine plus erlotinib for advanced pancreatic cancer:A systemic review with meta-analysis.PLoS ONE,2013;8:e57528.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical Analysis of Erlotinib-induced Severe Rash and Fatal Interstitial Lung Disease: A Case Report and Literature Review

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