EGFR-TKIs治疗晚期非小细胞肺癌并发间质性肺炎4例报告并文献复习

Interstitial pneumonia in EGFR-TKIs-treated non-small-cell lung cancer:report of 4 cases and review of the literature

目的总结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)在治疗晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)中所致间质性肺炎的临床表现、诊断和治疗。方法回顾性分析我科4例晚期NSCLC患者靶向治疗药物致间质性肺炎的临床表现、诊断、治疗经过及转归。结果 4例晚期NSCLC患者均接受了化疗,并分别因化疗后病情进展或不能耐受进一步化疗而口服吉非替尼或厄洛替尼,在EGFR-TKIs治疗后30 d内出现呼吸困难、咳嗽和低氧血症,并发间质性肺炎,其中3例病情进展迅速,因呼吸衰竭死亡,提示其预后凶险。结论对接受EGFR-TKIs治疗的患者,一旦出现呼吸困难和咳嗽,应及时进行胸部CT、肺功能、血气分析等相关检查。该类间质性肺炎预后凶险,病死率很高,一旦确诊间质性肺炎,应立即停用EGFR-TKIs,并及时予以足量激素及氧疗等对症治疗,必要时进行呼吸支持,才有可能改善其预后。

Objective To identify the clinical features,diagnosis and treatment of interstitial pneumonia related to epidermal growth factor receptor tyrosine kinase inhibitors（EGFR-TKIs） which were used in advanced non-small cell lung cancer（NSCLC）.Methods Retrospective analysis was carried out in 4 cases with NSCLC who developed interstitial pneumonia after EGFR-TKIs therapy in our department from March 2007 to September 2011.Their clinical features,diagnosis,treatment and outcome were analyzed.Results The 4 patients had previously received chemotherapy until disease progression or unacceptable toxicity and then turned to receive gefitinib or erlotinib orally.However,within 30 d after the treatment,the patients suffered from dyspnea,cough and hypoxemia and developed interstitial pneumonia.Three patients died of respiratory failure due to rapid disease progression,which reflected the poor prognosis of the interstitial pneumonia.Conclusion EGFRTKIs-related interstitial pneumonia is with poor prognosis and high mortality.Timely chest CT scanning,pulmonary function testing,blood gas analysis and other tests should be performed as soon as dyspnea,cough and hypoxemia are seen.Relevant treatment such as discontinuation of EGFR-TKIs immediately,use of corticosteroids,oxygen therapy and respiration supporting when necessary,can probably improve the prognosis and survival of patients.