厄洛替尼引起急性间质性肺病死亡2例  

Death from acute interstitial lung disease related to erlotinib:2 case reports

作　　者：雷莉[1] 罗继征[1] 孟军英[1] 宋迎新[1] 白云[1] 王仑[1] 王荃[1] 吴利群[1] 

机构地区：[1]北京军区总医院干二科,北京100700

出　　处：《药物不良反应杂志》2007年第4期277-278,共2页Adverse Drug Reactions Journal

摘　　要：2例男性肺癌患者口服厄洛替尼发生间质性肺病死亡。病例1,1名84岁男性肺腺癌并骨转移患者,因骨痛给予厄洛替尼150mg,1次/d口服。用药当晚患者开始发热,T38.3℃,伴咳嗽、咳痰,但骨痛有所减轻。给予头孢曲松钠抗感染治疗,体温恢复正常,病情逐渐恶化。服药11d后出现呼吸困难,在吸氧5L/min的情况下动脉血氧分压67.5mmHg,X线胸片示:双肺弥漫性间质病变,停用厄洛替尼。次日死于呼吸衰竭。病例2,1名69岁男性,因右肺鳞癌经化疗、放疗和对症治疗后,CT显示病灶稍有缩小,病情稳定。服用厄洛替尼150mg,1次/d。2d后,出现面部及躯干部皮疹,局部对症治疗后好转。服药29d后出现发热,咳嗽、气短加重,血常规:WBC10.2×109/L,抗感染治疗效果不明显。服药35d复查CT示双肺弥漫性间质病变,停厄洛替尼。次日病情急剧恶化,出现严重呼吸困难,动脉血气示低氧血症,第3天死于呼吸衰竭。Two old men with lung cancers died from interstitial lung disease during treatment with erlotinib. The first patient, an 84-year-old man with adenocarcinoma of lung and osseous metastasis was given erlotinib 150 mg once daily for osteodynia. At the first night, he developed a fever （T 38.3℃）, cough, and expectoration in spite of osteodynia relieved. After anti-infective therapy with ceftriaxone sodium, his body temperature returned to normal. But the patient＇s condition deteriorated gradually. After 11 days of erlotinib therapy, he developed dyspnea. His partial pressure of oxygen in arterial blood was 67.5 mmHg after treatment with oxygen 5 L/min. A chest X-ray revealed diffused interstitial change in the lungs. Erlotinib was withdrawn. The patient died of respiratory failure in the next day. The second patient, a 69-year-old man with right lung squamous carcinoma received chemotherapy, radiotherapy, and symptomatic therapy. A CT scan revealed the focus slightly decreased in size, and the patient＇s condition was stable. After 2 days of receiving erlotinib 150 mg once daily, he developed skin rash on face and think. His rash recovered by local symptomatic treatment. After 29 days of administration of erlotinib, he developed a fever, aggravation of cough and short breath. His count of WBC was 10.2×10^9/L. The efficacy of anti-infective therapy was not apparent. Repeat CT scan showed diffused interstitial change in the 1 ungs on day 35. Erlotinib was discontinued. The next day, the patient＇s condition aggravated suddenly. He presented with severe dyspnea. Arterial blood gas analysis revealed hypoxemia. On day 3 he died of respiratory failure.

关 键 词：厄洛替尼 间质性肺病 

分 类 号：R595.3[医药卫生—内科学]