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, 7 (3), 878-880

Rechallenge With Gefitinib Following Severe Drug-Induced Hepatotoxicity in a Patient With Advanced Non-Small Cell Lung Cancer: A Case Report and Literature Review

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Rechallenge With Gefitinib Following Severe Drug-Induced Hepatotoxicity in a Patient With Advanced Non-Small Cell Lung Cancer: A Case Report and Literature Review

Xueqin Chen et al. Oncol Lett.

Abstract

Gefitinib has come to be the most widely used epidermal growth factor receptor-tyrosine kinase inhibitor in the treatment of advanced non-small cell lung cancer (NSCLC) in Asian patients. Common side effects include mild to moderate skin rash and diarrhea, however, drug-induced liver injury of varying severity is overlooked in long-term gefitinib administration and rarely reported. The current case report presents a female Chinese NSCLC patient who developed severe gefitinib-induced hepatotoxicity and was rechallenged with gefitinib following a 3-month break. The patient achieved partial clinical remission but developed drug-induced grade 4 hepatotoxicity following gefitinib administration for 14 months. As an alternative, 4 cycles of chemotherapy were administered to control tumor progression. Following restoration of the patient's liver function, gefitinib was rechallenged together with active hepatoprotective therapy. The patient presented good disease control and maintained normal liver function for >6 months. Thus, sequential chemotherapy and gefitinib rechallenge with hepatoprotective therapy may be a potential new treatment strategy for gefitinib-induced hepatotoxicity.

Keywords: adverse drug reactions; epidermal growth factor; hepatotoxicity; tyrosine kinase inhibitor.

Figures

Figure 1
Figure 1
(A) Prior to gefitinib treatment, chest CT indicated a mass in the superior lobe of the left lung, encapsulated effusion in the left pleural cavity and atelectasis in the left lung. (B) Eight weeks after gefitinib treatment, CT revealed a marked decrease in lung lesion size and the disappearance of the hydrothorax. CT, computed tomography.
Figure 2
Figure 2
Changes in ALT during (A) hepatoprotective therapy and (B) chemotherapy. ALT, alanine aminotransferase.

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