Recovery from Gefitinib-induced Pneumonitis and Hepatitis after Changing to Erlotinib Treatment

Abstract

Both gefitinib and erlotinib are selective epidermal growth factor-receptor tyrosine kinase inhibitors (EGFR-TKI), and are effective in the treatment of advanced non-small-cell lung cancer (NSCLC). Drug-related adverse events are usually mild in degree when using these drugs. However, some patients may develop acute severe intersititial pneumonia or hepatitis, which is sometimes fatal. We describe herein the cases of two patients with NSCLC who suffered from gefitinib-induced acute interstitial pneumonia and hepatitis, respectively, and recovered after stopping gefitinib treatment; the patients subsequently received erlotinib treatment uneventfully. Case one was a 58-year-old man with stage Ⅳ NSCLC who received gefitinib as first-line therapy. He had a partial response after gefitinib treatment. However, progressive dyspnea occurred after six months of gefitinib therapy. Chest X-ray showed new-onset right upper and lower lobe ground-glass opacity and consolidation compatible with acute interstitial pneumonitis. Gefitinib therapy was discontinued, and the patient received oral corticosteroid and supplemental oxygen treatment. After the clinical symptoms subsided, the patient took erlotinib as second-line therapy without recurrence of pulmonary symptoms or interstitial pneumonia. Case two was a 77-year-old woman with stage IV adenocarcinoma who had received gefitinib as first-line therapy. She had a partial response to gefitinib after one month of treatment. However, the patient developed a poor appetite, nausea sensation, and grade 3 hepatitis after 2 months of treatment. After stopping gefitinib for two weeks, her liver function tests gradually improved, but did not return to normal range. She then took erlotinib (75 mg/day) as second-line therapy. She tolerated erlotinib therapy well, and liver enzymes (AST and ALT) returned to normal range again. When treating NSCLC patients with EGFR-TKI, it is important to evaluate carefully any new-onset respiratory and gastrointestinal symptoms. Arranging radiographic and hepatic examinations accordingly is needed whenever pulmonary or hepatic toxicity is suspected. Thus, a change from one EGFR-TKI to another EGFR-TKI is an appropriate choice if further EGFR-TKI treatment is still needed.