Reactions 1486, p16 - 1 Feb 2014 S Erlotinib Haemolytic anaemia: 2 case reports Two men, aged 56 years and 84 years, developed haemolytic anaemia while receiving erlotinib [routes not stated]. The younger man had metastatic bronchial carcinoma of the lung and bones. He was initially treated with carboplatin and paclitaxel. Due to thoracic tumour progression, he started erlotinib 150 mg/day. Four days later, he presented to an emergency department with severe dyspnoea and sinus tachycardia. Examination revealed pallor and cutaneo-mucosal subicterus. Tests showed a regenerative normocytic normochromic anaemia with a haemoglobin level of 6.8 g/dL and a reticulocyte level of 6%. He also had a non-conjugated bilirubin level of 84.9 µmol/L and a conjugated bilirubin level of 12.6 µmol/L. Erlotinib was withdrawn upon admission. He underwent blood transfusions, and received corticotherapy. His non-conjugated bilirubin level decreased, and his haemoglobin level was maintained at threshold levels; he no longer required transfusions on hospital day 5. He died on the day 6, in a context of massive deterioration of his general condition. The older man had an adenocarcinoma of the lower left lobe, metastatic from the outset in the lung. He received carboplatin and paclitaxel, and later started erlotinib 150 mg/day due to thoracic tumour progression. A month later, he presented with collapse and respiratory distress. An ECG showed sinus tachycardia, and tests showed regenerative normochromic macrocytic anaemia with a haemoglobin level of 6.8 g/dL, a reticulocyte level of 182 500/mm 3 , and high levels of bilirubin. Erlotinib was withdrawn at admission, and he received blood transfusions and corticotherapy. During the first week, corticotherapy did not allow reduction in the rate of blood transfusions, and his non-conjugated bilirubin level remained high. Due to progression in his illness, he received palliative care. He died 1 month after hospitalisation [cause of death not stated]. Author comment: We are reporting two cases of haemolytic anaemia, probably caused by an immune-allergic mechanism, which we attribute to erlotinib. Sakhri L, et al. Hemolytic anemia under erlotinib treatment. Revue de Pneumologie Clinique 69: 345-350, No. 6, Dec 2013. Available from: URL: http:// doi.org/10.1016/j.pneumo.2013.06.003 [French; summarised from a translation] - France 803098835 1 Reactions 1 Feb 2014 No. 1486 0114-9954/14/1486-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved

Erlotinib

Download PDF Report

Upload
sathish
View
212
Download
0

Embed Size (px)

Citation preview

Reactions 1486, p16 - 1 Feb 2014

SErlotinib

Haemolytic anaemia: 2 case reportsTwo men, aged 56 years and 84 years, developed

haemolytic anaemia while receiving erlotinib [routes notstated].

The younger man had metastatic bronchial carcinoma of thelung and bones. He was initially treated with carboplatin andpaclitaxel. Due to thoracic tumour progression, he startederlotinib 150 mg/day. Four days later, he presented to anemergency department with severe dyspnoea and sinustachycardia. Examination revealed pallor and cutaneo-mucosalsubicterus. Tests showed a regenerative normocyticnormochromic anaemia with a haemoglobin level of 6.8 g/dLand a reticulocyte level of 6%. He also had a non-conjugatedbilirubin level of 84.9 µmol/L and a conjugated bilirubin levelof 12.6 µmol/L. Erlotinib was withdrawn upon admission. Heunderwent blood transfusions, and received corticotherapy.His non-conjugated bilirubin level decreased, and hishaemoglobin level was maintained at threshold levels; he nolonger required transfusions on hospital day 5. He died on theday 6, in a context of massive deterioration of his generalcondition.

The older man had an adenocarcinoma of the lower leftlobe, metastatic from the outset in the lung. He receivedcarboplatin and paclitaxel, and later started erlotinib150 mg/day due to thoracic tumour progression. A monthlater, he presented with collapse and respiratory distress. AnECG showed sinus tachycardia, and tests showed regenerativenormochromic macrocytic anaemia with a haemoglobin levelof 6.8 g/dL, a reticulocyte level of 182 500/mm3, and highlevels of bilirubin. Erlotinib was withdrawn at admission, andhe received blood transfusions and corticotherapy. During thefirst week, corticotherapy did not allow reduction in the rate ofblood transfusions, and his non-conjugated bilirubin levelremained high. Due to progression in his illness, he receivedpalliative care. He died 1 month after hospitalisation [cause ofdeath not stated].

Author comment: We are reporting two cases ofhaemolytic anaemia, probably caused by an immune-allergicmechanism, which we attribute to erlotinib.Sakhri L, et al. Hemolytic anemia under erlotinib treatment. Revue dePneumologie Clinique 69: 345-350, No. 6, Dec 2013. Available from: URL: http://doi.org/10.1016/j.pneumo.2013.06.003 [French; summarised from a translation] -France 803098835