Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2021; 9(24): 7205-7211
Published online Aug 26, 2021. doi: 10.12998/wjcc.v9.i24.7205
Therapy-related myeloid leukemia during erlotinib treatment in a non-small cell lung cancer patient: A case report
So-My Koo, Ki-Up Kim, Yang-Ki Kim, Soo-Taek Uh
So-My Koo, Ki-Up Kim, Yang-Ki Kim, Soo-Taek Uh, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul 04401, South Korea
Author contributions: Koo SM and Kim KU designed research; Koo SM, Kim KU, Kim YK, and Uh ST performed research, analyzed data, and wrote the paper; all authors have read and approve the final manuscript.
Supported by Soonchunhyang University Research Fund.
Informed consent statement: The author provided informed consent.
Conflict-of-interest statement: Dr. Koo has nothing to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ki-Up Kim, MD, Professor, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, 59 Daesakwan-Ro, Yongsan-Ku, Seoul 04401, South Korea. kukim@schmc.ac.kr
Received: March 5, 2021
Peer-review started: March 5, 2021
First decision: April 24, 2021
Revised: April 27, 2021
Accepted: July 15, 2021
Article in press: July 15, 2021
Published online: August 26, 2021
Processing time: 171 Days and 17.5 Hours
Abstract
BACKGROUND

Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are tolerable drugs used for patients with EGFR-mutant advanced non-small cell lung cancer (NSCLC). Serious adverse reactions are uncommon compared with cytotoxic drugs.

CASE SUMMARY

A 52-year-old man presented with general weakness and cytopenia. He had been taking erlotinib for 11 mo to treat NSCLC. The pathological diagnosis from the right upper lobe mass was adenocarcinoma with an EGFR mutation in exon 21 (L858R). He had previously received paclitaxel/carboplatin, gemcitabin/ vinorelbine chemotherapy, stereotactic radiosurgery for brain metastasis, and whole-brain radiotherapy as treatment for NSCLC. We diagnosed the patient with acute myeloid leukemia (AML). During the induction and consolidation chemotherapy for AML, the erlotinib was discontinued. When complete remission of the AML was achieved, since the lung masses were increased, pemetrexed/ cisplatin for the NSCLC was initiated. After two cycles of chemotherapy, the cytopenia was prolonged. AML relapse occurred with the same karyotype.

CONCLUSION

Therapy-related acute myeloid neoplasm (t-MN) is a rare but fatal late complication. Although a patient may be taking EGFR-TKIs, the possibility of t-MN should be considered. Further studies are needed to determine whether EGFR-TKI usage is a predisposing factor for t-MN.

Keywords: Acute myeloid leukemia; Erlotinib; Neoplasm, second primary; Non-small cell lung cancer; Case report

Core Tip: Therapy-related acute myeloid leukemia (t-AML) developed during erlotinib treatment in a patient with epidermal growth factor receptor (EGFR)–mutant advanced non-small cell lung cancer (NSCLC). Alkylating cytotoxic drugs and radiotherapy are common treatments for patients with NSCLC. Cases of t-AML related to alkylating agents typically have a long latency period. Since it was 20 mo in this case, EGFR–tyrosine kinase inhibitor (EGFR-TKI) usage may be related to or hasten AML development in patients who previously received cytotoxic chemotherapy. Although the mechanism remains unclear, when a patient takes an EGFR-TKI, t-AML development should be considered, especially if cytopenia persists.