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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 re-treatment with gefitinib on CT scans. (a) before re-treatment, (b) after re-treatment.
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Figure 3: Radiological evaluation of response to re-treatment with gefitinib on CT scans. (a) before re-treatment, (b) after re-treatment.

Mentions: In the five months following the withdrawal of gefitinib, miliary pulmonary metastases with lymphangitis carcinomatosa gradually progressed (Figure 3a). The patient was confined to bed due to severe dyspnoea and rapidly progressing hypoxia. He was judged to be intolerant to further cytotoxic chemotherapy in consideration of his physical condition. He and his family strongly desired the readministration with gefitinib rather than palliative care. Gefitinib therapy with 50% dose (125 mg/day) was therefore initiated, after receiving informed consent for the use of an unproven treatment dose of gefitinib and the high risk of ILD relapse. Fortunately, the symptoms rapidly improved one week after therapy was resumed. A chest CT scan taken one month later showed a significant response (Figure 3b). Thereafter, disease progression of pulmonary and bone metastases was documented 6 months after readministration of gefitinib. His general condition gradually deteriorated with disease progression, and he expired 16 months after the readministration of gefitinib.


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 re-treatment with gefitinib on CT scans. (a) before re-treatment, (b) after re-treatment.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Radiological evaluation of response to re-treatment with gefitinib on CT scans. (a) before re-treatment, (b) after re-treatment.
Mentions: In the five months following the withdrawal of gefitinib, miliary pulmonary metastases with lymphangitis carcinomatosa gradually progressed (Figure 3a). The patient was confined to bed due to severe dyspnoea and rapidly progressing hypoxia. He was judged to be intolerant to further cytotoxic chemotherapy in consideration of his physical condition. He and his family strongly desired the readministration with gefitinib rather than palliative care. Gefitinib therapy with 50% dose (125 mg/day) was therefore initiated, after receiving informed consent for the use of an unproven treatment dose of gefitinib and the high risk of ILD relapse. Fortunately, the symptoms rapidly improved one week after therapy was resumed. A chest CT scan taken one month later showed a significant response (Figure 3b). Thereafter, disease progression of pulmonary and bone metastases was documented 6 months after readministration of gefitinib. His general condition gradually deteriorated with disease progression, and he expired 16 months after the readministration of gefitinib.

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