Severe megaloblastic anemia in a patient with advanced lung adenocarcinoma during treatment with erlotinib: a case report and literature review
Abstract Background Erlotinib is a first-generation, tyrosine kinase inhibitor of the epidermal growth factor receptor (EGFR-TKI) used for the treatment patients with NSCLC. Erlotinib is considered as a safe and effective treatment option, with generally good tolerance. Diarrhea and rash are the mos...
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-024-02935-9 |
| _version_ | 1797266982556401664 |
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| author | Xin Yan Jingxian Kong Jiacheng Wang Caixia Wang Hongchang Shen |
| author_facet | Xin Yan Jingxian Kong Jiacheng Wang Caixia Wang Hongchang Shen |
| author_sort | Xin Yan |
| collection | DOAJ |
| description | Abstract Background Erlotinib is a first-generation, tyrosine kinase inhibitor of the epidermal growth factor receptor (EGFR-TKI) used for the treatment patients with NSCLC. Erlotinib is considered as a safe and effective treatment option, with generally good tolerance. Diarrhea and rash are the most common side effects, and more rare side effects appear in long-term real-world applications. Severe erlotinib related megaloblastic anemia is rare and remains unreported. This is the first case report of severe megaloblastic anemia in a patient with advanced lung adenocarcinoma with an EGFR L858R mutation treated with erlotinib. In this report, the clinical manifestations, diagnosis and treatment of erlotinib related severe megaloblastic anemia are described, and the possible pathogenesis and related treatment options are discussed. Case description Herein, we present a 57- year-old non-smoking female diagnosed with metastatic lung adenocarcinoma harboring an EGFR L858R mutation, who had received erlotinib as the first-line therapy. After 44 weeks of treatment, the patient developed severe anemia. Anemia was manifested as megaloblastic anemia with elevated mean corpuscular volume and mean corpuscular hemoglobin. The total vitamin B12 level was below the detection limit of 50.00 pg /mL. Bone marrow smear suggested megaloblastic anemia. Her hematologic parameters were markedly recovered following the withdrawal of erlotinib and vitamin B12 supplement. As a result, the patient was diagnosed with erlotinib-associated megaloblastic anemia. Conclusions This is the first case of severe megaloblastic anemia reported with erlotinib. Few of these hematologic adverse effects have been observed in studies on erlotinib, this case report highlights this possibility for long-term erlotinib administration. Close clinical and blood monitoring is recommended for patients receiving long-term TKI therapy. |
| first_indexed | 2024-04-25T01:09:20Z |
| format | Article |
| id | doaj.art-6532b5f34ad0425980a6c2529e2704ca |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-04-25T01:09:20Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-6532b5f34ad0425980a6c2529e2704ca2024-03-10T12:05:00ZengBMCBMC Pulmonary Medicine1471-24662024-03-012411410.1186/s12890-024-02935-9Severe megaloblastic anemia in a patient with advanced lung adenocarcinoma during treatment with erlotinib: a case report and literature reviewXin Yan0Jingxian Kong1Jiacheng Wang2Caixia Wang3Hongchang Shen4Department of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityDepartment of Gastroenterological surgery, Shanxian Central HospitalDepartment of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityDepartment of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityDepartment of Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical UniversityAbstract Background Erlotinib is a first-generation, tyrosine kinase inhibitor of the epidermal growth factor receptor (EGFR-TKI) used for the treatment patients with NSCLC. Erlotinib is considered as a safe and effective treatment option, with generally good tolerance. Diarrhea and rash are the most common side effects, and more rare side effects appear in long-term real-world applications. Severe erlotinib related megaloblastic anemia is rare and remains unreported. This is the first case report of severe megaloblastic anemia in a patient with advanced lung adenocarcinoma with an EGFR L858R mutation treated with erlotinib. In this report, the clinical manifestations, diagnosis and treatment of erlotinib related severe megaloblastic anemia are described, and the possible pathogenesis and related treatment options are discussed. Case description Herein, we present a 57- year-old non-smoking female diagnosed with metastatic lung adenocarcinoma harboring an EGFR L858R mutation, who had received erlotinib as the first-line therapy. After 44 weeks of treatment, the patient developed severe anemia. Anemia was manifested as megaloblastic anemia with elevated mean corpuscular volume and mean corpuscular hemoglobin. The total vitamin B12 level was below the detection limit of 50.00 pg /mL. Bone marrow smear suggested megaloblastic anemia. Her hematologic parameters were markedly recovered following the withdrawal of erlotinib and vitamin B12 supplement. As a result, the patient was diagnosed with erlotinib-associated megaloblastic anemia. Conclusions This is the first case of severe megaloblastic anemia reported with erlotinib. Few of these hematologic adverse effects have been observed in studies on erlotinib, this case report highlights this possibility for long-term erlotinib administration. Close clinical and blood monitoring is recommended for patients receiving long-term TKI therapy.https://doi.org/10.1186/s12890-024-02935-9Megaloblastic anemiaLung adenocarcinomaErlotinib |
| spellingShingle | Xin Yan Jingxian Kong Jiacheng Wang Caixia Wang Hongchang Shen Severe megaloblastic anemia in a patient with advanced lung adenocarcinoma during treatment with erlotinib: a case report and literature review BMC Pulmonary Medicine Megaloblastic anemia Lung adenocarcinoma Erlotinib |
| title | Severe megaloblastic anemia in a patient with advanced lung adenocarcinoma during treatment with erlotinib: a case report and literature review |
| title_full | Severe megaloblastic anemia in a patient with advanced lung adenocarcinoma during treatment with erlotinib: a case report and literature review |
| title_fullStr | Severe megaloblastic anemia in a patient with advanced lung adenocarcinoma during treatment with erlotinib: a case report and literature review |
| title_full_unstemmed | Severe megaloblastic anemia in a patient with advanced lung adenocarcinoma during treatment with erlotinib: a case report and literature review |
| title_short | Severe megaloblastic anemia in a patient with advanced lung adenocarcinoma during treatment with erlotinib: a case report and literature review |
| title_sort | severe megaloblastic anemia in a patient with advanced lung adenocarcinoma during treatment with erlotinib a case report and literature review |
| topic | Megaloblastic anemia Lung adenocarcinoma Erlotinib |
| url | https://doi.org/10.1186/s12890-024-02935-9 |
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