Gastrointestinal perforations in patients treated with erlotinib: A report of two cases with fatal outcome and literature review

Lung Cancer. 2016 Sep:99:76-8. doi: 10.1016/j.lungcan.2016.06.012. Epub 2016 Jun 14.

Abstract

Erlotinib has been approved as second-line treatment in patients with non-small cell lung cancer (NSCLC) experiencing relapse after first-line platinum-based chemotherapy. Herein, we report two occurrences of erlotinib-associated gastrointestinal perforation (GIP) in NSCLC patients. Two patients aged 60 and 79 years received erlotinib as third- and second-line NSCLC treatment, respectively. GIP occurred following 3 weeks and 6 months of erlotinib treatment, leading to death a few days later in both patients, neither of whom had any intestinal metastasis. Risk factors related to erlotinib-induced GIP were concomitant oral corticosteroid therapy and ciprofloxacin administration, which may result in erlotinib overexposure. GIP is a severe adverse drug reaction of erlotinib, infrequently described in the literature, compared to other targeted therapies. The lethal risk of erlotinib-associated GIP should be taken into account when evaluating the benefit-risk balance of erlotinib in patients without epidermal growth factor receptor activating mutations.

Keywords: Adverse drug reaction; Erlotinib; Gastrointestinal perforation.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Carcinoma, Non-Small-Cell Lung / complications
  • Carcinoma, Non-Small-Cell Lung / diagnosis
  • Carcinoma, Non-Small-Cell Lung / drug therapy
  • Erlotinib Hydrochloride / adverse effects*
  • Erlotinib Hydrochloride / therapeutic use
  • Fatal Outcome
  • Humans
  • Intestinal Perforation / diagnosis
  • Intestinal Perforation / etiology*
  • Intestinal Perforation / therapy
  • Lung Neoplasms / complications
  • Lung Neoplasms / diagnosis
  • Lung Neoplasms / drug therapy
  • Male
  • Middle Aged
  • Protein Kinase Inhibitors / adverse effects*
  • Protein Kinase Inhibitors / therapeutic use
  • Radiography, Thoracic
  • Stomach Diseases / diagnosis
  • Stomach Diseases / etiology*
  • Stomach Diseases / therapy
  • Tomography, X-Ray Computed

Substances

  • Antineoplastic Agents
  • Protein Kinase Inhibitors
  • Erlotinib Hydrochloride