• Nenhum resultado encontrado

Sao Paulo Med. J. vol.127 número3


Academic year: 2018

Share "Sao Paulo Med. J. vol.127 número3"




Sao Paulo Med J. 2009; 127(3):177-8


Letter to editor

Development of rheumatoid arthritis during the course

of geitinib therapy

Desenvolvimento de artrite reumática no curso de terapia de geitinib

Gen Ohara


, Hiroaki Satoh


, Mika Kohno


, Daisuke Goto


, Takayuki Sumida


, Nobuyuki Hizawa


Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-city, Ibaraki, Japan

1MD. Member of the medical staff, Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-city, Ibaraki, Japan. 2MD. Professor, Division of Respiratory Medicine, Mito Medical Center, University of Tsukuba, Mito, Ibaraki, Japan.

3MD. Member of the medical staff, Division of Rheumatology Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-city, Ibaraki, Japan. 4MD. Professor, Division of Rheumatology Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-city, Ibaraki, Japan.

5MD. Professor, Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-city, Ibaraki, Japan.

We read with interest the article by del Giglio and Ito on arthralgia as an adverse efect in non-small cell lung cancer (NSCLC) patients treated with geitinib.1 We would like to share our experience.

A 57-year-old woman with no smoking history was admitted because of a nodular lesion that was detected inci-dentally by a chest radiograph. A chest computed tomography (CT) scan demonstrated a left lung mass with intra-pulmonary metastases.

Pathology samples obtained by transbronchial biopsy conirmed adenocarcinoma of the lung. Brain magnetic resonance imaging (MRI) showed three nodules, up to 10 mm in diameter, consistent with metastatic disease. She received gamma-knife radiosurgery. hereafter, she received 250 mg geitinib per day. A chest CT scan on day 28 re-vealed regression of the primary lesion.

Seven months after starting on geitinib, she showed swelling with pain on movement, accompanied with morn-ing stifness almost symmetrically in the bilateral metacarpophalangeal and proximal interphalangeal joints. Swellmorn-ing and pain were observed bilaterally in the knee and ankle joints. hese symptoms continued for two months. Labo-ratory data demonstrated positive inlammatory reactions, including the erythrocyte sedimentation rate (90 mm/1 h) and C-reactive protein (1.70 mg/dl). he rheumatoid factor and matrix metalloproteinase-3 concentrations were 161 U/ml and 74.8 ng/ml, respectively. She was diagnosed as having rheumatoid arthritis, according to the standard classiication criteria.2

Oral prednisolone was started at an initial dose of 5 mg per day. Sulfasalazine was then started at a dose of 500 mg daily, orally. Soon after this therapy, her arthritis showed improvement and inlammatory reactions decreased. She has since been treated with geitinib and prednisolone, and has been in a good general condition without recur-rence of lung adenocarcinoma and arthralgia due to rheumatoid arthritis for 12 months.

Geitinib is an oral selective inhibitor of the epidermal growth factor receptor (EGFR) tyrosine kinase, and its use is now being attempted for patients with advanced non-small cell lung cancer (NSCLC).3,4 Our case was a lung

adenocarcinoma patient who developed rheumatoid arthritis seven months after starting on geitinib therapy. In this report, we emphasize two points.

First, prednisolone and sulfasalazine are widely used for treating rheumatoid arthritis, although there are serious possible complications, including infection, gastric ulcer, diabetes, skin eruption, and myelosuppression. he inlu-ence of steroids on geitinib therapy for NSCLC has scarcely been reported.5 he initial therapy applied in our case


Sao Paulo Med J. 2009; 127(3):177-8 Ohara G, Satoh H, Kohno M, Goto D, Sumida T, Hizawa N


Second, the development of rheumatoid arthritis after starting ge-itinib therapy is an extremely rare event and does not depend on pre-vious rheumatic manifestations. Although del Giglio and Ito described mild arthralgia in two NSCLC patients treated with geitinib,1 our

as-sessment is that geitinib does not work as a “trigger” leading to deregu-lation of the immune cascade, even in subjects genetically predisposed to develop rheumatoid arthritis.


1. del Giglio A, Ito C. Geitinib (Iressa) in metastatic patients with non-small cell lung cancer: preliminary experience in a Brazilian center. Sao Paulo Med J. 2004;122(3):128-30. 2. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised

criteria for the classiication of rheumatoid arthritis. Arthritis Rheum. 1988;31(3):315-24. 3. Fukuoka M, Yano S, Giaccone G, et al. Multi-institutional randomized phase II trial of geitinib

for previously treated patients with advanced non-small-cell lung cancer (The IDEAL 1 Trial) [corrected]. J Clin Oncol. 2003;21(12):2237-46.

4. Kris MG, Natale RB, Herbst RS, et al. Eficacy of geitinib, an inhibitor of the epidermal growth

factor receptor tyrosine kinase, in symptomatic patients with non-small cell lung cancer: a randomized trial. JAMA. 2003;290(16):2149-58.

5. Seiverling EV, Fernanadez EM, Adams D. Epidermal growth factor receptor (EGFR) inhibitor associated skin eruption. J Drugs Dermatol. 2006;5(4):368-9.

Sources of funding: None

Conlict of interest: None

Date of irst submission: January 19, 2009

Last received: March 27, 2009

Accepted: June 24, 2009

Address for correspondence: Hiroaki Satoh

Division of Respiratory Medicine

Institute of Clinical Medicine, University of Tsukuba, Tsukuba-city, Ibaraki, 305-8575, Japan Tel. +81-29-853-3210


Documentos relacionados

advances have renewed the interest in tracheal transplantation among investigators, there are still some questions to be resolved before tracheal transplantation could be

Surgeon in the Lung Transplant Group, Instituto do Coração (InCor), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil2.

Among those who could give a reason for their use of homeopathy, lack of improvement (“did not help”) through using conventional medicine was the main jus- tiication for

Our objective was to measure the prevalence of HSIL and cervical cancer among women with a cytological diagnosis of HSIL who were referred to a colposcopy clinic, at which

his paper aimed to study how Public Health has become part of undergraduate medical courses, by picking out its tenets and the implications of these proposals

Starting from this issue, the São Paulo Medical Journal/Evidence for Health Care and the journal Diag- nóstico & Tratamento will have a section for disseminating short abstracts

he most evident risk factor for the presence of endometriosis in scar tissue is a previous history of obstetric surgical procedures, es- pecially cesarean sections, and hundreds

Women with histories of recurrent spontaneous abortion, fetal death, preterm birth or early neonatal death seem to have poorer qual- ity of life and greater symptoms of

Since early diagnosis of celiac disease may avoid repercussions re- garding bone metabolism, the present study was conducted with the aims of determining the frequencies

Prevalence of cervical intraepithelial neoplasia grades II/III and cervical cancer in patients with cytological diagnosis of atypical squamous cells when high-grade

Over recent decades, with the clear value placed on scientiic production from teachers and the absence of tools for evaluating teaching at the bedside (and for evaluating patients),

herefore, based on these concepts, the objective of this study was to evaluate the efect of preservation of the medial pectoral nerve during modiied mastectomy procedures,

To add new information to the growing body of lit- erature in women with these lesions, we aimed to evaluate the distribu- tion of single and multiple infections of diferent HPV

RESULTS: In the estriol-treated patients, in comparison with the control group, a signiicant increase in ER gene expression was observed in the endometrium and vagina, while

Studying the epidemiological aspects of renal diseases, both primary and secondary, may help to identify the frequency of glomerulopathy or other kidney diseases, their causes,

METHODS: The following variables were analyzed: age, histological type, degree of differentiation, invasion of lymphatic, vascular and perineural space, lymph node

CONCLUSIONS: This experience suggests that negative pressure therapy may have an important role in wound bed preparation and as part of the treatment for wounds

Head of Neurology Service, Department of Internal Medicine, Hospital das Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, Paraná,

OR (Fibrous Histiocytoma, Malignant) Or (Fibrous Histiocytomas, Malignant) Or (His- tiocytomas, Malignant Fibrous) Or (Malignant Fibrous Histiocytomas) Or (Malignant Fibrous

Os empregados das entidades públicas que não se identifiquem como funcionários ou extra-numerários em serviço nas próprias repartições e, ainda, que não prestem ser- viço em

Tendo um olhar voltado para a infância, o eu-lírico do Livro sobre nada, na seção “Arte de infantilizar formigas”, remonta este período marcante de sua vida, expondo a sua

To test whether ouabain was able to inhibit migration in other lung cancer cells, we treated the human non-small cell lung cancer cell line H460 with ouabain (0–30 pM) and subjected

Deste modo, serão estudadas as três dimensões nucleares das funções executivas, isto é o controlo inibitório, a memória de trabalho e a flexibilidade cognitiva, avaliadas antes e