Erlotinib
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Rash and gastrointestinal toxicities: 24 case reports In a retrospective review of 157 patients treated with erlotinib for non-small cell lung cancer (NSCLC) between 2005 and 2018, 24 patients including a 58-year-old woman [not all ages and sexes stated] were described, who developed diarrhoea, gastrointestinal toxicities (GT) or rash during treatment with erlotinib for the NSCLC [routes and duration of treatment to reaction onset not stated; not all dosages and outcomes stated]. The patients started receiving erlotinib for NSCLC. All patients presented after a treatment time ranging 0–58 months. The CT findings were split between two groups: a diffuse pattern (10 patient) and segmental pattern (14 patients). The imaging findings involved the large bowel and no small bowel involvement. The most common findings included fluid-filled bowel and stool (n=23). Additional findings included mesenteric vessel engorgement (n=3), mesenteric vessel engorgement and pericolonic stranding (n=7), mild bowel wall thickening (n=3) or homogenous mucosal enhancement (n=5). On the basis of these findings, all patients were diagnosed with grade 1–4 erlotinib-associated GT and diarrhoea. Additionally, four patients developed skin toxicity in the form of rash. At that time, the best response to erlotinib therapy was assessed as disease progression (n=5), stable disease (n=13), partial response (n=3) and complete response (n=3). All patients with stable disease or partial response had GT with grade 3+, while patients with disease progression had GT with grade 0–2. Therefore, treatment modification was required in 8 patients as follows: dose reduction due to rash and multiple interruptions due to GT (n=2), cessation of erlotinib therapy due to rash and GT (n=1), initial dose reduction followed by cessation of erlotinib therapy due to GT (n=1), drug interruption due to rash (n=1), dose reduction from initial 150 mg/day to 100 mg/day due to GT (n=2) and decrease in treatment frequency to every third day (n=1). Fifteen patients received pharmacologic therapy with loperamide (n=10), maintenance steroids (n=4) and diphenoxylate/atropine (n=1). Six patients required no change in erlotinib therapy or treatment intervention. Follow-up imaging was performed for 20 patients indicating resolution of GT. Two deaths were reported in the study [causes of deaths not stated]. One 58-year-old woman was admitted to the ICU with sepsis and symptoms of severe abdominal pain and diarrhoea. The CT scan of the woman revealed a moderate amount of ascites, fluid-filled sigmoid colon and rectum with air-fluid levels and diffuse circumferential wall thickening. Infectious workup was negative. She was diagnosed with grade 1 GT and diarrhoea. She also developed skin toxicity in the form of rash. Her erlotinib therapy was discontinued. She was started on comfort measures due to poor clinical status and eventually died during her hospitalisation period. The other patient with grade 4 diarrhoea and GT died during evaluation of GT. Pfau D, et al. Imaging features of
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