title: Atypical response to erlotinib in a patient with metastatic lung adenocarcinoma: a case report.
abstract: BACKGROUND
  Tyrosine kinase inhibitors are widely prescribed in thoracic oncology and have excellent responses as a first-line treatment for locally advanced or metastatic lung cancer with epidermal growth factor receptor mutations. The side effects of tyrosine kinase inhibitors are mostly gastrointestinal and dermatological, and are usually resolved after symptomatic treatment. However, new complications have now arisen due to increased use of these drugs. Here we report a side effect of erlotinib that has not been described previously: that is, metastatic lung tumor nodules were transformed into cysts, which ruptured the pleura and were responsible for bilateral life-threatening pneumothorax.
  
  
  METHODS
  We report the case of a 35-year-old Caucasian woman with metastatic adenocarcinoma and a deletion in epidermal growth factor receptor exon 19 (del E746-A750). She was treated with erlotinib for metastatic lung adenocarcinoma. Treatment with erlotinib resulted in the replacement of pulmonary tumor nodules with air-containing cysts. These cysts ruptured in the pleura causing a life-threatening bilateral pneumothorax. To the best of our knowledge, this tumor-cystic response after erlotinib therapy has not been previously described.
  
  
  CONCLUSIONS
  Tyrosine kinase inhibitors are widely prescribed in thoracic oncology, and managing toxicities must be optimal in order to improve adherence. Transformation of pulmonary nodules into cysts must be known and clinicians should be aware of this potential complication, which can lead to life-threatening pneumothorax.
authors.affiliation: Pôle thorax et vaisseaux, Unité d'oncologie thoracique, CHU Grenoble, BP217, 38043 Grenoble cedex 9, France. lsakhri@chu-grenoble.fr.
authors.forename: Linda
authors.initials: L
authors.lastname: Sakhri
authors.forename: Elodie
authors.initials: E
authors.lastname: Meynet
authors.forename: Léonie
authors.initials: L
authors.lastname: Ferrer
authors.forename: Augustin
authors.initials: A
authors.lastname: Pirvu
authors.forename: Gilbert
authors.initials: G
authors.lastname: Ferretti
authors.forename: Denis
authors.initials: D
authors.lastname: Moro-Sibilot
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D000077192:Adenocarcinoma of Lung; D000328:Adult; D003560:Cysts / Q000139:chemically induced* / Q000150:complications; D000069347:Erlotinib Hydrochloride; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D009362:Neoplasm Metastasis; D011030:Pneumothorax / Q000209:etiology*; D047428:Protein Kinase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011799:Quinazolines / Q000009:adverse effects* / Q000627:therapeutic use; D012422:Rupture, Spontaneous / Q000150:complications
chemical_list: D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D000069347:Erlotinib Hydrochloride