Toxicidad muco-cutánea: un desafío en el tratamiento oncológico <span class="so-article-trans-title" dir="auto"> Translated title: Mucocutaneous toxicity: a challenge in oncological treatment </span>

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Abstract

Resumen El tratamiento combinado con inhibidores de tirosina quinasa e inmunoterapia en el cáncer de pulmón avanzado con mutación del EGFR es un enfoque emergente en la investigación clínica. Algunos estudios preliminares han mostrado resultados prometedores, con mejorías en la respuesta tumoral y la supervivencia global en comparación con la monoterapia. Sin embargo, esta combinación puede aumentar el riesgo de eventos adversos, por lo que se requiere un seguimiento estrecho y una atención médica especializada. Se presenta el caso de un varón de 57 años con adenocarcinoma de pulmón que manifestó exantema generalizado grado 3 con lesiones pápulo-pustulosas, paroniquia y tricomegalia secundario al tratamiento con lazertinib-amivantamab. Además, el paciente desarrolló una proctalgia crónica con mal control álgico debido a la aparición de úlceras anales e hipertonía del esfínter anal.

Translated abstract

Abstract The combined treatment with tyrosine kinase inhibitors and immunotherapy in advanced lung cancer with EGFR mutation is an emerging approach in clinical research. Some preliminary studies have shown promising results, with improvements in tumor response and overall survival compared to monotherapy. However, this combination may increase the risk of adverse events, necessitating close monitoring and specialized medical attention. We present the case of a 57-year-old male with lung adenocarcinoma who manifested grade 3 generalized exanthema with papulopustular lesions, paronychia and trichomegaly secondary to treatment with lazertinib-amivantamab. Additionally, the patient developed chronic proctalgia with poorly controlled pain due to the presence of anal ulcers and anal sphincter hypertonia.

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Non–Small Cell Lung Cancer: Epidemiology, Screening, Diagnosis, and Treatment

Narjust Duma, Rafael Santana-Davila, Julian R. Molina (2019)

Lung cancer remains the leading cause of cancer deaths in the United States. In the past decade, significant advances have been made in the science of non-small cell lung cancer (NSCLC). Screening has been introduced with the goal of early detection. The National Lung Screening Trial found a lung cancer mortality benefit of 20% and a 6.7% decrease in all-cause mortality with the use of low-dose chest computed tomography in high-risk individuals. The treatment of lung cancer has also evolved with the introduction of several lines of tyrosine kinase inhibitors in patients with EGFR, ALK, ROS1, and NTRK mutations. Similarly, immune checkpoint inhibitors (ICIs) have dramatically changed the landscape of NSCLC treatment. Furthermore, the results of new trials continue to help us understand the role of these novel agents and which patients are more likely to benefit; ICIs are now part of the first-line NSCLC treatment armamentarium as monotherapy, combined with chemotherapy, or after definite chemoradiotherapy in patients with stage III unresectable NSCLC. Expression of programmed cell death protein-ligand 1 in malignant cells has been studied as a potential biomarker for response to ICIs. However, important drawbacks exist that limit its discriminatory potential. Identification of accurate predictive biomarkers beyond programmed cell death protein-ligand 1 expression remains essential to select the most appropriate candidates for ICI therapy. Many questions remain unanswered regarding the proper sequence and combinations of these new agents; however, the field is moving rapidly, and the overall direction is optimistic.

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Amivantamab in EGFR Exon 20 Insertion–Mutated Non–Small-Cell Lung Cancer Progressing on Platinum Chemotherapy: Initial Results From the CHRYSALIS Phase I Study

Keunchil Park, Eric B. Haura, Natasha B Leighl … (2021)

PURPOSE Non–small-cell lung cancer (NSCLC) with epidermal growth factor receptor ( EGFR ) exon 20 insertion (Exon20ins) mutations exhibits inherent resistance to approved tyrosine kinase inhibitors. Amivantamab, an EGFR-MET bispecific antibody with immune cell–directing activity, binds to each receptor's extracellular domain, bypassing resistance at the tyrosine kinase inhibitor binding site. METHODS CHRYSALIS is a phase I, open-label, dose-escalation, and dose-expansion study, which included a population with EGFR Exon20ins NSCLC. The primary end points were dose-limiting toxicity and overall response rate. We report findings from the postplatinum EGFR Exon20ins NSCLC population treated at the recommended phase II dose of 1,050 mg amivantamab (1,400 mg, ≥ 80 kg) given once weekly for the first 4 weeks and then once every 2 weeks starting at week 5. RESULTS In the efficacy population (n = 81), the median age was 62 years (range, 42-84 years); 40 patients (49%) were Asian, and the median number of previous lines of therapy was two (range, 1-7). The overall response rate was 40% (95% CI, 29 to 51), including three complete responses, with a median duration of response of 11.1 months (95% CI, 6.9 to not reached). The median progression-free survival was 8.3 months (95% CI, 6.5 to 10.9). In the safety population (n = 114), the most common adverse events were rash in 98 patients (86%), infusion-related reactions in 75 (66%), and paronychia in 51 (45%). The most common grade 3-4 adverse events were hypokalemia in six patients (5%) and rash, pulmonary embolism, diarrhea, and neutropenia in four (4%) each. Treatment-related dose reductions and discontinuations were reported in 13% and 4% of patients, respectively. CONCLUSION Amivantamab, via its novel mechanism of action, yielded robust and durable responses with tolerable safety in patients with EGFR Exon20ins mutations after progression on platinum-based chemotherapy.

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Precision Management of Advanced Non–Small Cell Lung Cancer

Ching-Yao Yang, James Yang, Pan-Chyr Yang (2020)

The rapid evolution of treatment for advanced lung cancer is a story of how scientists have struggled to move from nonselective cytotoxic chemotherapy to personalized precision medicine. In this century, extraordinary advances have been made in the management of advanced and metastatic non–small cell lung cancer, especially in the development of small molecules targeting specific tyrosine kinase receptors and immune checkpoint inhibitors. These developments have led to a significant improvement in survival for lung cancer patients with metastatic disease. Now, the core guidelines to treat non–small cell lung cancer are based on the identification of targetable driver mutations and immune checkpoints. Continued investigations of newly identified druggable genetic alterations, explorations of biomarkers of immune checkpoint inhibitors, development of next-generation immunotherapy, and optimization of combination therapy are necessary to provide better treatment outcomes for lung cancer patients in the future.

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Author and article information

Journal

Journal ID (publisher-id): had

Title: Hospital a Domicilio

Abbreviated Title: Hosp. domic.

Publisher: Centro Internacional Virtual de Investigación en Nutrición (CIVIN) (Alicante, Alicante, Spain )

ISSN (Electronic): 2530-5115

Publication date (Print and electronic): September 2023

Volume: 7

Issue: 3

Pages: 149-155

Affiliations

[1] Alicante orgnameHospital General Universitario de Alicante Doctor Balmis orgdiv1Unidad de Hospitalización a Domicilio, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL) España

Article

Publisher ID: S2530-51152023000300005 Publisher ID: S2530-5115(23)00700300005

DOI: 10.22585/hospdomic.v7i3.197

SO-VID: c7e587c9-ef24-4f06-b646-d531bcf22e61

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

History

Date received : 20 June 2023

Date accepted : 17 July 2023

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Figures: 0, Tables: 0, Equations: 0, References: 7, Pages: 7

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Toxicidad muco-cutánea: un desafío en el tratamiento oncológico Translated title: Mucocutaneous toxicity: a challenge in oncological treatment

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Most cited references 7

Non–Small Cell Lung Cancer: Epidemiology, Screening, Diagnosis, and Treatment

Amivantamab in EGFR Exon 20 Insertion–Mutated Non–Small-Cell Lung Cancer Progressing on Platinum Chemotherapy: Initial Results From the CHRYSALIS Phase I Study

Precision Management of Advanced Non–Small Cell Lung Cancer

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