Yi-Chun Lai and Jiun-I Lai
Background: Epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitors (TKIs) constitute the standard therapy for advanced stage non-small cell lung cancer. Compared with systemic chemotherapy, TKI based treatment has fewer adverse effects.
Patients and methods: We present a lung cancer patient with erlotinib associated severe liver toxicity and perform a systemic review on published studies that report EGFR-TKI-associated liver toxicity. We conducted a systemic search in Medline, PubMed, and Google for studies that were accessible.
Results: A total of 18 papers was found from which we analysed 16 studies with a total of 30 patients. This is the largest case numbers literature review. In these studies, abnormal liver function levels were reported around 75.4 ± 135.2 days after initiating EGFR- TKI treatment. Six patients (20%) died during the study period (23.8 ± 22.5 days after EGFR-TKI use) who were more likely to be Male, to use erlotinib, to receive EGFR- TKI as non-first line therapy, and to have liver metastasis.
Conclusion: From our analysis, male, erlotinib use, EGFR-TKI for second line or later use, and initial liver metastasis were associated with higher mortality after EGFR-TKI-associated liver toxicity. The underlying mechanism is unknown, and further studies are required to validate these results.
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