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Readministration of gefitinib in a responder after treatment discontinuation due to gefinitib-related interstitial lung disease: a case report.

Takamochi K, Suzuki K, Bashar AH, Yajima K, Mochizuki T, Itaya T, Funai K - J Med Case Rep (2007)

Bottom Line: Gefitinib is considered to be well tolerated and less toxic compared with conventional cytotoxic drugs.However, interstitial lung disease (ILD) has been reported as a serious adverse effect.A reduced dose of gefitinib might be sufficient for patients having tumors with EGFR gene mutations, and that the currently approved dose may be excessively potent in some of these patients, thus resulting in the onset of adverse events.

View Article: PubMed Central - HTML - PubMed

Affiliation: First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 435-3192 Japan. ktakamoc@hama-med.ac.jp.

ABSTRACT

Introduction: Gefitinib is a new molecular-targeted agent for the treatment of patients with advanced non-small cell lung cancer that fail to respond to conventional chemotherapy. Gefitinib is considered to be well tolerated and less toxic compared with conventional cytotoxic drugs. However, interstitial lung disease (ILD) has been reported as a serious adverse effect. The precise management of a gefitinib responder having severe adverse events remains unknown.

Case presentation: We report the case of gefitinib readministration in a patient with lung adenocarcinoma who had once responded but in whom treatment had to be discontinued owing to gefinitib-related ILD. A dramatic response was achieved both at the time of initial treatment (250 mg/day) and at readministration of gefitinib (125 mg/day). The effectiveness of gefitinib therapy in our patient could be explained in part by the presence of an activating mutation of epidermal growth factor receptor (EGFR) gene, L858R in exon 21, which was identified in the primary tumor.

Conclusion: A reduced dose of gefitinib might be sufficient for patients having tumors with EGFR gene mutations, and that the currently approved dose may be excessively potent in some of these patients, thus resulting in the onset of adverse events.

No MeSH data available.


Related in: MedlinePlus

Radiological evaluation of response to initial treatment with gefitinib on CT cans. (a) before treatment, (b) after treatment.
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Figure 1: Radiological evaluation of response to initial treatment with gefitinib on CT cans. (a) before treatment, (b) after treatment.

Mentions: Multiple bone metastases developed 10 months after the operation. He received two courses of chemotherapy (cisplatin/docetaxel) and palliative irradiation therapy. Subsequently, at 17 months after the operation, a follow-up CT scan indicated miliary pulmonary metastases with lymphangitis carcinomatosa throughout both lungs and mediastinal lymphadenopathy (Figure 1a). ILD was not evident on a chest CT scan. No respiratory symptoms were noted. Multiple brain metastases were simultaneously detected on brain magnetic resonance imaging. The oral administration of gefitinib 250 mg/day and whole brain irradiation therapy (total 30 Gy/12 fr) were initiated. A rapid improvement in multiple pulmonary metastases was observed 14 days after the administration of gefitinib (Figure 1b). Brain metastatic lesions showed a mild regression.


Readministration of gefitinib in a responder after treatment discontinuation due to gefinitib-related interstitial lung disease: a case report.

Takamochi K, Suzuki K, Bashar AH, Yajima K, Mochizuki T, Itaya T, Funai K - J Med Case Rep (2007)

Radiological evaluation of response to initial treatment with gefitinib on CT cans. (a) before treatment, (b) after treatment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2194710&req=5

Figure 1: Radiological evaluation of response to initial treatment with gefitinib on CT cans. (a) before treatment, (b) after treatment.
Mentions: Multiple bone metastases developed 10 months after the operation. He received two courses of chemotherapy (cisplatin/docetaxel) and palliative irradiation therapy. Subsequently, at 17 months after the operation, a follow-up CT scan indicated miliary pulmonary metastases with lymphangitis carcinomatosa throughout both lungs and mediastinal lymphadenopathy (Figure 1a). ILD was not evident on a chest CT scan. No respiratory symptoms were noted. Multiple brain metastases were simultaneously detected on brain magnetic resonance imaging. The oral administration of gefitinib 250 mg/day and whole brain irradiation therapy (total 30 Gy/12 fr) were initiated. A rapid improvement in multiple pulmonary metastases was observed 14 days after the administration of gefitinib (Figure 1b). Brain metastatic lesions showed a mild regression.

Bottom Line: Gefitinib is considered to be well tolerated and less toxic compared with conventional cytotoxic drugs.However, interstitial lung disease (ILD) has been reported as a serious adverse effect.A reduced dose of gefitinib might be sufficient for patients having tumors with EGFR gene mutations, and that the currently approved dose may be excessively potent in some of these patients, thus resulting in the onset of adverse events.

View Article: PubMed Central - HTML - PubMed

Affiliation: First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 435-3192 Japan. ktakamoc@hama-med.ac.jp.

ABSTRACT

Introduction: Gefitinib is a new molecular-targeted agent for the treatment of patients with advanced non-small cell lung cancer that fail to respond to conventional chemotherapy. Gefitinib is considered to be well tolerated and less toxic compared with conventional cytotoxic drugs. However, interstitial lung disease (ILD) has been reported as a serious adverse effect. The precise management of a gefitinib responder having severe adverse events remains unknown.

Case presentation: We report the case of gefitinib readministration in a patient with lung adenocarcinoma who had once responded but in whom treatment had to be discontinued owing to gefinitib-related ILD. A dramatic response was achieved both at the time of initial treatment (250 mg/day) and at readministration of gefitinib (125 mg/day). The effectiveness of gefitinib therapy in our patient could be explained in part by the presence of an activating mutation of epidermal growth factor receptor (EGFR) gene, L858R in exon 21, which was identified in the primary tumor.

Conclusion: A reduced dose of gefitinib might be sufficient for patients having tumors with EGFR gene mutations, and that the currently approved dose may be excessively potent in some of these patients, thus resulting in the onset of adverse events.

No MeSH data available.


Related in: MedlinePlus