背景:厄洛替尼是第一代,表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKI)用于治疗NSCLC患者。厄洛替尼被认为是一种安全有效的治疗选择。总体上具有良好的耐受性。腹泻和皮疹是最常见的副作用,更罕见的副作用出现在长期的实际应用中。严重的厄洛替尼相关性巨幼细胞性贫血很少见,目前尚未报道。这是用厄洛替尼治疗的EGFRL858R突变的晚期肺腺癌患者中严重巨幼细胞性贫血的首例病例报告。在这份报告中,临床表现,描述了厄洛替尼相关的严重巨幼细胞性贫血的诊断和治疗,并讨论了可能的发病机制和相关治疗方案。
方法:这里,我们介绍了一名57岁的非吸烟女性,被诊断患有具有EGFRL858R突变的转移性肺腺癌,谁曾接受埃罗替尼作为一线治疗。治疗44周后,患者出现严重贫血。贫血表现为巨幼细胞性贫血,平均红细胞体积和平均红细胞血红蛋白升高。总维生素B12水平低于50.00pg/mL的检测限。骨髓涂片提示巨幼细胞性贫血。在停用厄洛替尼和维生素B12补充剂后,她的血液学参数明显恢复。因此,患者被诊断为厄洛替尼相关性巨幼细胞性贫血.
结论:这是埃罗替尼报道的首例严重巨幼细胞性贫血。在厄洛替尼的研究中很少观察到这些血液学不良反应,本病例报告强调了厄洛替尼长期给药的可能性.对于接受长期TKI治疗的患者,建议进行密切的临床和血液监测。
BACKGROUND: Erlotinib is a first-generation, tyrosine kinase inhibitor of the epidermal growth factor receptor (EGFR-TKI) used for the treatment patients with NSCLC. Erlotinib is considered as a safe and effective treatment option, with generally good tolerance. Diarrhea and rash are the most common side effects, and more rare side effects appear in long-term real-world applications. Severe erlotinib related megaloblastic anemia is rare and remains unreported. This is the first case report of severe megaloblastic anemia in a patient with advanced lung adenocarcinoma with an EGFR L858R mutation treated with erlotinib. In this report, the clinical manifestations, diagnosis and treatment of erlotinib related severe megaloblastic anemia are described, and the possible pathogenesis and related treatment options are discussed.
METHODS: Herein, we present a 57- year-old non-smoking female diagnosed with metastatic lung adenocarcinoma harboring an EGFR L858R mutation, who had received erlotinib as the first-line therapy. After 44 weeks of treatment, the patient developed severe anemia. Anemia was manifested as megaloblastic anemia with elevated mean corpuscular volume and mean corpuscular hemoglobin. The total vitamin B12 level was below the detection limit of 50.00 pg /mL. Bone marrow smear suggested megaloblastic anemia. Her hematologic parameters were markedly recovered following the withdrawal of erlotinib and vitamin B12 supplement. As a result, the patient was diagnosed with erlotinib-associated megaloblastic anemia.
CONCLUSIONS: This is the first case of severe megaloblastic anemia reported with erlotinib. Few of these hematologic adverse effects have been observed in studies on erlotinib, this case report highlights this possibility for long-term erlotinib administration. Close clinical and blood monitoring is recommended for patients receiving long-term TKI therapy.