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作 者:周玉琳 李瑞琪 孙文 陈辉 李敏 冯觉平[2] ZHOU Yulin;LI Ruiqi;SUN Wen;CHEN Hui;LI Min;FENG Jueping(School of Medicine,Jianghan University,Wuhan 430056,Hubei,China;Department of Oncology,Wuhan Fourth Hospital,Wuhan 430034,Hubei,China)
机构地区:[1]江汉大学医学部,湖北武汉430056 [2]武汉市第四医院肿瘤科,湖北武汉430034
出 处:《江汉大学学报(自然科学版)》2025年第2期79-86,共8页Journal of Jianghan University:Natural Science Edition
基 金:国家重大公共卫生服务项目补助资金-国家癌症早诊早治项目(鄂卫办发[2023]5号);武汉市“323”攻坚-癌症防治行动专项经费项目(2022-2023)。
摘 要:目的探讨新型三代表皮生长因子受体酪氨酸激酶抑制剂(epidermal growth factor receptor-tyrosine kinase inhibitors,EGFR-TKIs)阿美替尼所引发的血清肌酸激酶(creatine kinase,CK)异常增高的特征、与剂量的关系、相关血清学变化及对治疗决策的影响。方法分析1例采用常规剂量阿美替尼治疗的肺腺癌患者的临床表现、影像学及病理特征,并进行文献复习。结果一名59岁的女性肺腺癌、EGFR21外显子L858R突变患者,接受阿美替尼110 mg/d治疗167 d出现CK增高到峰值760 U/L(CTCAE 3级以上),停药30 d CK降至正常范围。期间无肌肉疼痛等症状,血清学、影像学检查未发现心脏毒性或肌炎的证据。采用阿美替尼每周减量110 mg后CK稳定在CTCAE 1级范围。结论阿美替尼治疗期间可出现无症状性CK增高,持续CK增高对患者心血管的长期效应及对CK增高的干预策略尚不确定。建议在阿美替尼治疗期间密切观察肌肉疼痛等临床症状并监测血清CK水平。Objective Exploring the characteristics of abnormal elevation of serum creatine kinase(CK)induced by the novel three representative epidermal growth factor receptor tyrosine kinase inhibitors(EGFR-TKIs)aumolertinib,its relationship with dosage,related serological changes,and its impact on treatment decision-making.Methods The clinical manifestations,imaging,and pathological features of a patient with lung adenocarcinoma treated with a routine dose of aumolertinib were analyzed,and the literature was reviewed.Results In a 59-year-old female patient with lung adenocarcinoma and EGFR21 exon L858R mutation,CK increased to a peak of 760 U/L(CTCAE grade 3 or above)on 167 days after aumolertinib 110 mg/d treatment,and CK decreased to the normal range on 30 days after withdrawal.During this period,there were no symptoms such as muscle pain,and no evidence of cardiac toxicity or myositis was found in serological and imaging examinations.After aumolertinib was reduced by 110 mg weekly,CK stabilized in the CTCAE level 1 range.Conclusion Asymptomatic elevation of CK may occur during treatment with aumolertinib.The long-term effects of sustained CK elevation on cardiovascular function in patients and the intervention strategies for CK elevation are still uncertain.It is recommended to closely observe clinical symptoms such as muscle pain and monitor serum CK levels during the treatment with aumolertinib.
关 键 词:阿美替尼 肌酸激酶 肺腺癌 表皮生长因子受体-酪氨酸激酶抑制剂
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