Surprising Pitfall of Osimertinib-Associated Toxic Epidermal Necrolysis in a Patient with EGFR-Mutated Lung Cancer -- A Case Report

令人意想不到的陷阱－標靶藥物治療肺腺癌造成中毒性表皮壞死性症候群──個案報告

Yu-Tse Weng(翁御哲)；Yi-Shang Yu(余奕尚)；Chien-Wei Wu(吳建緯)；Chih-Chun Hou(侯智鈞)；Sheng-Lin Tsai(蔡昇霖)；Ting-Hsuan Liu(劉庭軒)；Lin Yin Wang(王淩音)；Hao-Yu Chiao(喬浩禹)

osimertinib ； EGFR-mutated lung cancer ； toxic epidermal necrolysis

臺灣整形外科醫學會雜誌

33卷2期（2024 / 06 / 01）

207 - 219

英文;繁體中文

Background: Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors are revolutionary therapeutic agents for advanced EGFR mutation-positive malignancies. However, in recent decades, severe cutaneous reactions, such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have rarely been reported in patients treated with these medications. Aim and objective: To present a rare case of osimertinib-associated TEN in a patient with metastatic non-small cell lung cancer. Previous reports on the association between SJS/TEN and osimertinib are scarce. Herein, we share a surprising case of a woman with EGFR-mutated lung cancer who presented with osimertinib-associated TEN. Materials and methods: We report a case of osimertinib-associated TEN in a patient with metastatic non-small cell lung cancer. The two main strategies used for patient care included fluid management and the use of silver dressings for wound care. Most importantly, a careful examination of the patient's medical history is crucial. Results: The mucocutaneous wound eruptions gradually improved and healed with modern dressing coverage. The steroid dose was tapered, and the patient's condition stabilized. After a 20-day conservative treatment, the wound had almost healed. The patient was transferred to the general ward and discharged 1 month later. After 6 months of follow-up, the patient recovered completely with some pigmentation and no scarring. Conclusion: EGFR tyrosine kinase inhibitors have revolutionized the field of oncology. However, the incidence of cutaneous adverse events is likely to increase with the emergence of the disease. Additionally, a meticulous medical history is important for determining the etiology of SJS/TENs. Therefore, early cessation of medication and comprehensive management of the associated skin toxicities are important.

背景：標靶藥物治療對於晚期的惡性腫瘤是一種革命性治療方法。然而，有些報告指出，少數人接受這些藥物治療的患者會出現藥物不良反應反應，甚至是嚴重的皮膚不良反應，例如史蒂夫強森綜合徵和中毒性表皮壞死溶解症。目的及目標：介紹罕見案例使用奧希替尼，治療轉移性肺線癌患者造成嚴重皮膚不良反應，中毒性表皮壞死溶解症的病例。材料及方法：我們報告了一名59歲女性使用奧希替尼，一種抗癌標靶治療藥物，治療轉移性肺線癌造成嚴重皮膚不良反應，中毒性表皮壞死溶解症。我們治療的主要策略有兩個重點。第一、嚴密的體液監測，2）應用含銀敷料照護傷口。最後，詳細地審查任何可能造成中毒性表皮壞死溶解症的藥物也是很重要的。結果：我們的策略取得了令人滿意的結果。傷口情況逐漸好轉並癒合，類固醇劑量逐漸減量。經過20天的保守治療，患者病情逐漸穩定，我們將患者轉到普通病房，並於一個月後出院。出院後6個月的追蹤，患者完全康復沒有留下任何疤痕，只有部分色素沉著。結論：標靶藥物徹底改變了腫瘤學領域。然而，隨著它們的普及，皮膚不良事件的發生率亦慢慢增加。我們也需要詳細地審查任何可能造成中毒性表皮壞死溶解症的藥物。因此，相關皮膚毒性的早期診斷和處理非常重要。