대한한방내과학회지 (The Journal of Internal Korean Medicine)

대한한방내과학회 (The Society of Internal Korean Medicine)
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Gefitinib 내성 후 Erlotinb과 한방 치료를 병행하여 호전된 뇌전이를 동반한 재발성 L858R 변이 비소세포폐암 환자 1례

A Case Report of Recurrent L858R Mutation Non-Small-Cell Lung Cancer with Brain Metastases Treated with Erlotinib and Traditional Korean Medicine After Failure with Gefitinib

  • 양정민 (장덕한방병원) ;
  • 장권준 (장덕한방병원) ;
  • 황우석 (경희대학교대학원 임상한의학과 폐계내과학교실)
  • Yang, Jung-min (Jangdeuk Korean Medicine Hospital) ;
  • Jang, Kwon-jun (Jangdeuk Korean Medicine Hospital) ;
  • Hwang, Woo-seok (Division of Allergy, Immune & Respiratory System, Dept. of Internal Medicine, Graduate School, Kyung Hee University)
  • 투고 : 2022.09.07
  • 심사 : 2022.11.01
  • 발행 : 2022.10.30
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초록

Objectives: The purpose of this study is to report the case of a patient with recurrent L858R mutation non-small-cell lung cancer with brain metastases treated with erlotinib and traditional Korean medicine after gefitinib failure. Methods: The patient was treated with erlotinib beginning in November 2021, and gamma knife surgery was performed on November 8, 2021. The dose of erlotinib was 150 mg/day every four weeks. At the same time, the patient was treated with traditional Korean medicine. Tumor size and cerebral edema were measured using computed tomography and magnetic resonance imaging, respectively. Adverse events were evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0. Results: After treatment with erlotinib and traditional Korean medicine for six months, the extent of the growing nodule in the right upper lobe decreased during the first three months and remained stable for the following three months. Peritumoral edema showed an increase three months after gamma knife surgery, but partial improvement of cerebral edema was confirmed with additional traditional Korean medicine six months after gamma knife surgery. The symptoms of discomfort and physical activity gradually improved. Conclusions: This case study suggests that the combination of EGFR-TKI and traditional Korean medicine may contribute to a reduction in tumor size and cerebral edema while improving quality of life.

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참고문헌

  1. 2020년 통계청 사망원인통계(국가승인통계 제101054호)( 2021년 9월 발표)
  2. 2021년 국가암등록사업 연례 보고서 (2019년 암등록통계). file:///C:/Users/pc/Downloads/2019%EB%85%84%%EA%B5%AD%EA%B0%80%EC%95%94%EB%93%B1%EB%A1%9D%EC%82%AC%EC%97%85%%EC%97%B0%EB%A1%80%EB%B3%B4%EA%B3%A0%EC%84%9C-%EC%B5%9C%EC%A2%85.pdf
  3. Kim JS, Kang EJ. Targeted Therapy for Non-Small Cell Lung Cancer. The Korean Journal of Medicine 2020;95(2):78-88. https://doi.org/10.3904/kjm.2020.95.2.78
  4. 가톨릭대학교 서울성모병원 종양내과 강진형 교수 인터뷰. 2018.01.10. 서울성모병원-메디트리트저널. http://www.mediherald.com/news/articleView.html?idxno=52122
  5. Song SY. Synergistic Effect of HAD-B1 and Afatinib Against Gefitinib Resistance of Non-Small Cell Lung Cancer. A Dissertation Submitted to the Graduate School in Partial Fulfillment of Requirements for the Degree of Doctor of Korean Medicine, Department of Internal Medicine, Daejeon University 2022.
  6. Sohaib A. RECIST rules. Cancer Imaging 2012; 12(2):345-6. https://doi.org/10.1102/1470-7330.2012.9011
  7. Watanabe H, Okada M, Kaji Y, Satouchi M, Sato Y, Yamabe Y, et al. New Response Evaluation Criteria in Solid Tumours-Revised RECIST Guideline(version 1.1). Cancer &chemotherapy 2009;36(13):2495-501.
  8. Common Terminology Criteria for Adverse Events (CTCAE). National Cancer Institute.Available from: URL: https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm. Published 2020. Accessed August 14, 2020.
  9. National Comprehensive Cancer Network. Non-Small Cell Lung Cancer Metastatic. 2021.
  10. Choi JY, Kwon WC, Kim YJ. CT Findings of Disease with Elevated Serum D-Dimer Levels in an Emergency Room Setting. J Korean Soc Radiol 2012;66(1):93-103. https://doi.org/10.3348/jksr.2012.66.1.93
  11. NSCLC(비소세포폐암) 개요 및 치료제 동향. 2021.
  12. 한국바이오협회 한국바이오경제연구센터. file:///C:/Users/pc/Downloads/[bio%economy%brief]%131%ED%98%B8_nsclc(%EB%B9%84%EC%86%8C%EC%84%B8%ED%8F%AC%ED%8F%90%EC%95%94)%%EA%B0%9C%EC%9A%94%%EB%B0%8F%%EC%B9%98%EB%A3%8C%EC%A0%9C%%EB%8F%99%ED%96%A5_final.pdf
  13. Hideharu K, Yoshiaki A, Hayato K, Yuichi T, Noriyuki O, Johsuke H, et al. A case of EGFR mutation-positive lung adenocarcinoma in which the T790M allele fraction was increased by repeated EGFR-TKI treatment. Cancer Commun (Lond). 2019;39:67. https://doi.org/10.1186/s40880-019-0413-5
  14. Singh N, Jindal A, Behera D. Erlotinib usage after prior treatment with gefitinib in advanced non-small cell lung cancer: A clinical perspective and review of published literature. World J Clin Oncol 2014 Dec 10;5(5):858-64. https://doi.org/10.5306/wjco.v5.i5.858
  15. Cho KM, Keam BS, Kim TM, Lee SH, Kim DW, Heo DS. Clinical efficacy of erlotinib, a salvage treatment for non-small cell lung cancer patients following gefitinib failure. Korean J Intern Med 2015;30(6):891-8. https://doi.org/10.3904/kjim.2015.30.6.891
  16. Zhang Y, Sheng J, Kang S, Fang W, Yan Y, Hu Z, et al. Patients with Exon 19 Deletion Were Associated with Longer Progression-Free Survival Compared to Those with L858R Mutation after First-Line EGFR-TKIs for Advanced Non-Small Cell Lung Cancer: A Meta-Analysis. PLOS ONE 2014 Sep 15;9(9) :e107161. https://doi.org/10.1371/journal.pone.0107161
  17. Liang H, Pan Z, Wang W, Guo C, Chen D, Zhang J, et al. The alteration of T790M between 19 del and L858R in NSCLC in the course of EGFR-TKIs therapy: a literaturebased pooled analysis. J Thorac Dis 2018 Apr; 10(4):2311-20. https://doi.org/10.21037/jtd.2018.03.150
  18. Jung HJ, Kim JD. The Role of Korean Medicine for Treatment and Management for Lung Cancer. J of Kor Traditional Oncology 2015;20(1):45-54. https://doi.org/10.15432/JKTO.2015.20.1.045
  19. Yang JM, Jang KJ, Ko EB, Lee JY, Yoon MJ, Jo OY, et al. A Case Report on Recurrent Salivary Duct Carcinoma Treated with Casodex/Nolvadex and Traditional Korean Medicine. J Int Korean Med 2021;42(5):1062-73. https://doi.org/10.22246/jikm.2021.42.5.1062
  20. Jeong TY, Park BK, Lee YW, Cho CK, Yoo HS. Prospective Analysis on Survival Outcomes of Nonsmall Cell Lung Cancer Stages over IIIb Treated with HangAm-Dan. Chin J Lung Cancer 2010 Nov 20;13(11):1009-15.
  21. Kim JH, Shin HK. Analysis of Biological Experimenton Immunoactivity of Sipjeondabo-tang. Korean J Oriental Physiology & Pathology 2012;26(5):641-9.
  22. Park DI, Park BK, Kim WI. The Experimental Study on the Anti-allergic Effects of Sipjeondaebo -tang. Journal of physiology & pathology in Korean Medicine 2003;17(2):308-15.
  23. Osamu S. Jyuzen-taiho-to as a Treatment for Pruritus Cutaneous Senilis. Japanese journal of oriental medicine 2000;50(5):877-81.
  24. Jung I, Kim H, Moon S, Lee H, Kim B. Overview of Salvia miltiorrhiza as a Potential Therapeutic Agent for Various Diseases: An Update on Efficacy and Mechanisms of Action. Antioxidants (Basel) 2020 Sep;9(9):857. https://doi.org/10.3390/antiox9090857
  25. Song JH. Effects of Salviae Miltiorrhizae Radix on Brain Edema. Thesis for the Master's Degree of EAST-WEST medical science, Kyung Hee university 2010.
  26. Park CH, Kim YS. Effects of Salviae Miltiorrhizae Radix on Blood-Brain Barrier Impairment of ICH-Induced Rats. Kor J Herbology 2014;29(1):19-26. https://doi.org/10.6116/kjh.2014.29.1.19
  27. Park YK, Jung HW. Panax notoginseng inhibits LPS-induced pro-inflammatory mediators in microglia. The Korea journal of herbology 2006; 21(4):93-101.
  28. Jang KJ, Yang JM, Lee JY, Ko EB, Moon HR, Yoon MJ, et al. A Case Report on ROS1-positive Recurrent Non-small-cell Lung Cancer Treated with Crizotinib and Korean Medicine. J Int Korean Med 2021;42(5):820-32. https://doi.org/10.22246/jikm.2021.42.5.820
  29. Harat M, Lebioda A, Lasota J, Makarewicz R. Evaluation of Brain Edema Formation Defined By MRI After LINAC-based Stereotactic Radiosurgery. Radiol Oncol 2017 Jun;51(2):137-41. https://doi.org/10.1515/raon-2017-0018
  30. Gamma Knife for Brain Tumors: Latest Developments and What's on the Horizon. Two stereotactic radiosurgery experts take stock after Cleveland Clinic's 10,000th case. Apr. 28, 2022 / Neurosciences/ Brain Tumor - https://consultqd.clevelandclinic.org/gamma-knife-for-brain-tumors-latest-developments-and-whats-on-the-horizon/)
  31. Deng Y, Feng W, Wu J, Chen Z, Tang Y, Zhang H, et al. The concentration of erlotinib in the cerebrospinal fluid of patients with brain metastasis from non-small-cell lung cancer. Mol Clin Oncol 2014 Jan;2(1):116-20. https://doi.org/10.3892/mco.2013.190
  32. 식약처 임상시험 정보검색. https://nedrug.mfds.go.kr/searchClinic?page=1&searchYn=true&approvalStart=2019-07-18&approvalEnd=2022-07-18&searchType=ST3&searchKeyword=had&approvalDtStart=2019-07-18&approvalDtEnd=2022-07-18&clinicStepCode=&examFinish=&domestic=&gender=&age=&localList=000&localList2=000