■Regorafenib是一种口服多靶向酪氨酸激酶抑制剂(TKI),适用于治疗各种肿瘤类型,包括转移性胃肠道间质瘤(GIST),作为三线系统治疗。红细胞增多症,其特征是红细胞计数增加,血红蛋白,和血细胞比容水平,已被描述为一些抗血管生成TKIs的副作用,但从未与regorafenib给药有关。
一名58岁女性在接受手术切除盆腔肿块后被诊断为GIST外。三年后,伊马替尼的全身治疗是由于盆腔疾病复发而开始的.然而,六个月后,由于疾病进展,我们开了舒尼替尼,病人接受了四年。Regorafenib于2019年6月启动,六个月后,我们注意到红细胞计数和血红蛋白(Hb)水平增加。鉴于患者有临床获益,血细胞比容在正常范围内,我们只监测血细胞计数,并继续给予相同剂量的瑞戈非尼.由于严重急性呼吸道综合症冠状病毒2(SARS-CoV-2)感染住院,该药物被停用超过六周,Hb水平恢复正常。因此,我们决定以较低的剂量重新开始瑞戈非尼.然而,血红蛋白水平再次上升,同时血细胞比容增加,导致需要多次静脉切除术。我们试图每隔一天重启Regorafenib,但没有成功,所以我们在2023年5月永久停止了它,所有值都恢复正常。
■Regorafenib可能会导致继发性红细胞增多症,与剂量无关,正如这个案例报告所暗示的。继发性红细胞增多症可能是TKI疗效的标志,考虑到患者在瑞戈非尼治疗期间(48个月)的长期临床获益。在接受regorafenib的患者中,建议监测血细胞计数以及与红细胞增多症相关的任何症状。
UNASSIGNED: Regorafenib is an oral multi-targeted tyrosine kinase inhibitor (TKI) indicated for the treatment of various tumor types, including metastatic gastrointestinal stromal tumors (GIST), as a third-line systemic therapy. Erythrocytosis, which is characterized by an increase in erythrocyte count, hemoglobin, and hematocrit levels, has been described as a side effect of some antiangiogenic
TKIs but has never been associated with regorafenib administration.
UNASSIGNED: An extra-GIST was diagnosed in a 58-year-old woman after she underwent surgery to remove a pelvic mass. Three years later, systemic therapy with imatinib was started due to pelvic disease recurrence. However, after six months, due to disease progression, we prescribed sunitinib, which the patient received for four years. Regorafenib was initiated in June 2019, and after six months, we noted an increase in the erythrocytes\' count and hemoglobin (Hb) levels. Given that the patient had clinical benefit and hematocrit was within normal range, we only monitored the blood cell count and continued to give regorafenib at the same dose. The drug was then stopped for over six weeks due to hospitalization for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and Hb levels returned to normal. Therefore, we decided to restart regorafenib at a lower dose. However, Hb levels rose again in conjunction with increased hematocrit, resulting in the need for multiple phlebotomies. We attempted to restart regorafenib every other day, but it was unsuccessful, so we stopped it permanently in May 2023, and all values returned to normal.
UNASSIGNED: Regorafenib may cause secondary erythrocytosis that could not be dose-related, as this case report suggests. Secondary erythrocytosis might be a marker of TKI efficacy, given the patient\'s prolonged clinical benefit during regorafenib treatment (48 months). In patients receiving regorafenib, monitoring blood count as well as any symptoms associated with erythrocytosis may be suggested.