Adverse Event Of Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitor (TKI) Treatment In Medan Among Pulmonary Adenocarcinoma: Focus On Non-Hematologic Toxicity
DOI:
https://doi.org/10.51601/ijhp.v5i3.429Abstract
This study aims to compare the non-hematological toxicities of first and second-generation Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitors (TKIs) in pulmonary adenocarcinoma patients with positive EGFR mutations in Medan. Utilizing a retrospective cross-sectional design, data were collected from medical records of 66 patients at three hospitals between January 2017 and December 2022. The study population included all patients meeting the specific criteria, and a total sampling technique was used. The collected data on demographics and non-hematological side effects were analyzed using the SPSS program, with the Kolmogorov-Smirnov and chi-square tests. The results indicate that second-generation TKIs exhibit lower non-hematological toxicities, specifically for skin rash, stomatitis, and diarrhea, compared to first-generation TKIs. However, a significant association was found between second-generation TKIs and a higher incidence of paronychia. All observed side effects were low-grade. The study's limitations include its retrospective nature and focus on non-hematological toxicities. Future research should investigate the toxicity profiles of second-generation TKIs further, including hematological side effects.
Downloads
References
World Health Organization, "Cancer," 2022. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/cancer.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J. Clin. 2021;71(3):209–49.
Fajrinur F, Handini MC, Tarigan FL, Harefa K, Ginting D. Ketidaklengkapan Pengisian Dokumen Clinical Pathway Kanker Paru (Studi Kualitatif di RSUP H. Adam Malik tahun 2021). J Healthc Technol Med. 2022;8(1):477–88.
Siddiqui F, Vaqar S, Siddiqu AH. Lung Cancer. StatPearls. 2023.
Wright NMA, Goss GD. Third-generation epidermal growth factor receptor tyrosine kinase inhibitors for the treatment of non-small cell lung cancer. Transl. Lung Cancer Res. 2019;8(Suppl 3):S247–64.
Sigismund S, Avanzato D, Lanzetti L. Emerging functions of the EGFR in cancer. Mol Oncol. 2018;12(1):3–20.
Bartholomew C, Eastlake L, Dunn P, Yiannakis D. EGFR targeted therapy in lung cancer; an evolving story. Respir Med Case Reports. 2017;20:137–40.
Chi A, Remick S, Tse W. EGFR inhibition in non-small cell lung cancer: Current evidence and future directions. Biomark Res. 2013;1(1):1.
Ellis PM, Coakley N, Feld R, Kuruvilla S, Ung YC. Use of the epidermal growth factor receptor inhibitors gefitinib, erlotinib, afatinib, dacomitinib, and icotinib in the treatment of non-small-cell lung cancer: A systematic review. Curr Oncol. 2015;22(3):e183–215.
Tan CS, Kumarakulasinghe NB, Huang YQ, Ang YLE, Choo JRE, Goh BC, et al. Third generation EGFR TKIs: Current data and future directions. Mol Cancer. 2018;17(1):1–14.
Lahmadi M, Beddar L, Rouibah AL, Boumegoura A, Boufendi H, Temim A, et al. Analysis of EGFR Mutation Status in Algerian Patients with Non-Small Cell Lung Cancer. Asian Pacific J Cancer Prev. 2021;22(4):1063–8.
Bian D, Sun L, Hu J, Duan L, Xia H, Zhu X, et al. Neoadjuvant Afatinib for stage III EGFR-mutant non-small cell lung cancer: a phase II study. Nat Commun. 2023;14(1):1–14.
Rodak O, Peris-Díaz MD, Olbromski M, Podhorska-Okołów M, Dzięgiel P. Current landscape of non-small cell lung cancer: Epidemiology, histological classification, targeted therapies, and immunotherapy. Cancers (Basel). 2021;13(18).
Hsu WH, Yang JCH, Mok TS, Loong HH. Overview of current systemic management of EGFR-mutant NSCLC. Ann Oncol. 2018;29(Suppl 1):i3–9.
Zhang P, Nie X, Bie Z, Li L. Impact of heavy smoking on the benefits from first-line EGFR-TKI therapy in patients with advanced lung adenocarcinoma. Medicine (United States). 2018;97(9):1–5.
Bian D, Sun L, Hu J, Duan L, Xia H, Zhu X, et al. Neoadjuvant Afatinib for stage III EGFR-mutant non-small cell lung cancer: a phase II study. Nat Commun. 2023;14(1):1–14.
Wu SG, Chang YL, Yu CJ, Yang PC, Shih JY. Lung adenocarcinoma patients of young age have lower EGFR mutation rate and poorer efficacy of EGFR tyrosine kinase inhibitors. ERJ Open Res. 2017;3(3).
Kobayashi Y, Togashi Y, Yatabe Y, Mizuuchi H, Jangchul P, Kondo C, et al. EGFR Exon 18 Mutations in Lung Cancer: Molecular Predictors of Augmented Sensitivity to Afatinib or Neratinib as Compared with First- or Third-Generation TKIs. Clin Cancer Res. 2015;21(23):5305–13.
Lahmadi M, Beddar L, Rouibah AL, Boumegoura A, Boufendi H, Temim A, et al. Analysis of EGFR Mutation Status in Algerian Patients with Non-Small Cell Lung Cancer. Asian Pacific J Cancer Prev. 2021;22(4):1063–8.
Zheng M. Classification and Pathology of Lung Cancer. Surg Oncol Clin N Am. 2016;25(3):447–68.
Setyawan UA, Tantular R, Bahar C. Survival Rate of Lung Adenocarcinoma Patients Receiving EGFR - Tyrosine Kinase Inhibitor Targeted Therapy. J Kedokt Brawijaya. 2023;32(3):165–70.
Chen YY, Yen YT, Lai WW, Huang WL, Chang CC, Tseng YL. Outcomes of salvage lung resections in advanced EGFR-mutant lung adenocarcinomas under EGFR TKIs. Thorac Cancer. 2021;12(20):2655–65.
Sari S, Andayani TM, Endarti D, Widayati K. Efikasi Afatinib dan Gefitinib pada Pasien Non-small Cell Lung Cancer EGFR Mutasi Positif: Tinjauan Sistematis. Indones J Clin Pharm. 2019;8(4):289.
Arena C, Troiano G, De Lillo A, Testa NF, Lo Muzio L. Stomatitis and VEGFR-Tyrosine Kinase Inhibitors (VR-TKIs): A Review of Current Literature in 4369 Patients. Biomed Res Int. 2018;2018:7–12.
Cárdenas-Fernández D, Pina PS, Turcott JG, Chávez-Tapia N, Conde-Flores E, Cardona AF, et al. Management of diarrhea induced by EGFR-TKIs in advanced lung adenocarcinoma. Ther Adv Vaccines. 2018;9(6):259–61.
Aw DCW, Tan EH, Chin TM, Lim HL, Lee HY, Soo RA. Management of epidermal growth factor receptor tyrosine kinase inhibitor-related cutaneous and gastrointestinal toxicities. Asia Pac J Clin Oncol. 2018;14(1):23–31.
Zhu Y, Li L, Zhang P, Zuo Y, Lei Y, Bai J, et al. Severe stomatitis caused by osimertinib combined with gefitinib: A case report. Clin Case Reports. 2022;10(2):3–7.
Relhan V, Bansal A. Acute and chronic paronychia revisited: A narrative review. J Cutan Aesthet Surg. 2022;15(1):1–16.
Masago K, Irie K, Fujita S, Imamichi F, Okada Y, Katakami N, et al. Relationship between Paronychia and Drug Concentrations of Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors. Oncology. 2018;95(4):251–6.
Kim Y, Lee SH, Ahn JS, Ahn MJ, Park K, Sun JM. Efficacy and safety of afatinib for EGFR-mutant non-small cell lung cancer, compared with gefitinib or erlotinib. Cancer Res Treat. 2019;51(2):502–9.
HE J, HUANG Z, HAN L, GONG Y, XIE C. Mechanisms and management of 3rd-generation EGFR-TKI resistance in advanced non-small cell lung cancer (Review). Int J Oncol. 2021;59(5):1–20.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Putri Wulandari Harahap, Setia Putra Tarigan, Noni Novisari Soeroso
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
