title: Gastrointestinal perforations in patients treated with erlotinib: A report of two cases with fatal outcome and literature review.
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.
authors: Pharmacy-Sterilisation Department, Strasbourg University Hospital, 1 place de l'hôpital, 67091 Strasbourg cedex, France.
authors: Florence
authors: F
authors: Gass-Jégu
authors: Chest Disease Department, Strasbourg University Hospital, 1 place de l'hôpital, 67091 Strasbourg cedex, France.
authors: Anthony
authors: A
authors: Gschwend
authors: Pharmacy-Sterilisation Department, Strasbourg University Hospital, 1 place de l'hôpital, 67091 Strasbourg cedex, France.
authors: Anne-Cécile
authors: AC
authors: Gairard-Dory
authors: Chest Disease Department, Strasbourg University Hospital, 1 place de l'hôpital, 67091 Strasbourg cedex, France.
authors: Bertrand
authors: B
authors: Mennecier
authors: Pharmacovigilance Department, Strasbourg University Hospital, 1 place de l'hôpital, 67091 Strasbourg cedex, France.
authors: Martine
authors: M
authors: Tebacher-Alt
authors: Pharmacy-Sterilisation Department, Strasbourg University Hospital, 1 place de l'hôpital, 67091 Strasbourg cedex, France.
authors: Bénédicte
authors: B
authors: Gourieux
authors: Chest Disease Department, Strasbourg University Hospital, 1 place de l'hôpital, 67091 Strasbourg cedex, France. Electronic address: elisabeth.quoix@chru-strasbourg.fr.
authors: Élisabeth
authors: É
authors: Quoix
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D000069347:Erlotinib Hydrochloride / Q000009:adverse effects* / Q000627:therapeutic use; D017809:Fatal Outcome; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D013902:Radiography, Thoracic; D013272:Stomach Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D000069347:Erlotinib Hydrochloride
keywords: Adverse drug reaction; Erlotinib; Gastrointestinal perforation