甲磺酸阿帕替尼片致手足皮肤反应2例

Apatinib mesylate tablets-induced hand-foot skin reaction: report of two cases

2例男性患者(例1,54岁;例2,63岁)分别因贲门胃底腺癌和左肺癌服用甲磺酸阿帕替尼片(阿帕替尼)治疗。例1在服用阿帕替尼(850 mg/d)第22天出现四肢末端、肛周及生殖器周围散在红斑伴肿胀,考虑为阿帕替尼引发的手足皮肤反应(HFSR),停用阿帕替尼,给予维生素B6口服、维生素E乳膏局部外涂。停药后皮肤症状有所减轻,遂在停药第7天减量应用阿帕替尼(750 mg/d)。恢复用药第57天,患者皮肤症状加重,再次停药。其后又经历2次给药(阿帕替尼剂量500和250 mg/d)、停药,均在用药后症状加重而停药后症状减轻,最终终止阿帕替尼治疗。例2在服用阿帕替尼剂量(500 mg/d)第35天双手掌、双足底出现皮肤红斑、肿胀伴疼痛;第85天,手、足皮肤出现脱屑、圆形角质化斑,腋窝、肛周、腹股沟也出现散在红斑伴脱屑,皮损处疼痛加重,诊断为阿帕替尼引发的HFSR,停用该药并给予对症治疗。停药第17天,皮肤症状好转,再次应用阿帕替尼(500 mg/d)。约2周后,患者皮肤症状复均加重,遂停药。

Two male patients (patient 1, 54 years old;patient 2, 63 years old) were treated with apatinib mesylate tablets (apatinib) for adenocarcinoma of cardia and gastric fundus and left lung cancer, respectively. Patient 1 developed erythema and swelling on the extremities, perianal, and perigenital on day 22 after taking apatinib (850 mg/d). Apatinib-induced hand-foot skin reaction (HFSR) was considered. Then apatinib was discontinued, oral vitamin B6 and topical external vitamin E cream were given. After withdrawal of apatinib, his skin symptoms alleviated, and apatinib (750 mg/d) was re-given on day 7 after withdrawal. On day 57 after the resumption of apatinib, the patient′s skin symptoms worsened and the medication was discontinued again. Afterwards, apatinib was given and then discontinued for 2 times (first 500 mg/d and then 250 mg/d). Because the symptoms aggravated after medication and alleviated after discontinuation, apatinib treatment was terminated finally. Patient 2 developed skin erythema, swelling, and pain on the palms and soles on day 35 after apatinib treatment at a dose of 500 mg/d. On day 85, he developed skin desquamation and circular keratosis of hands and feet, scattered erythema with desquamation in axilla, perianal region and groin, and increased pain in the skin lesions. Apatinib-induced HFSR was diagnosed. Apatinib was discontinued and symptomatic treatments were given. On day 17 of drug withdrawal, his skin symptoms improved and apatinib (500 mg/d) was given again. About 2 weeks later, the patient′s skin symptoms aggravated again, and the drug was discontinued.