| dc.description.abstract | Background: Lung cancer is estimated to be the third most common cancer after breast and prostate cancer and is estimated to be the leading cause of cancer death in the United States in 2021. One of the therapeutic modalities, namely targeted therapy with a mechanism of inhibition of EGFR activity, causes a cascade of cellular events that produce several adverse events (AE) of the skin, including rash, dry skin, pruritus, and inflammation of the nails/periungual tissue.1,2 The inhibitory effect of EGFR activity not only occurs on the skin but also in the gastrointestinal tract, impaired liver function, paronychia, and alopecia. Based on the common mutation type EGFR mutation, several studies reported more toxicity occurrences in Exon 19 Del than Exon 21 L858R.3-5
Objective: This study was to determine the toxicity profile of EGFR-TKI in lung adenocarcinoma patients with exon 19 Del and 21 L858R mutations at H. Adam Malik Hospital Medan.
Methods: This study is a descriptive study with a cross-sectional design at the Oncology Polyclinic at H Adam Malik General Hospital Medan from January 2017 to December 2020. The subjects of this study were all patients with lung adenocarcinoma with EGFR mutations exon 19 Del and exon 21 L858R receiving TKI EGFR treatment. The relationship between toxicity grading and EGFR mutations was analyzed using the Chi-Square test or the Likelihood Ratio test if the Chi-Square test conditions were not met.
Results: The incidence of toxicity occurred in 87 subjects, while only one subject did not have toxicity. From the data, it was found that the highest incidence of toxicity was skin rash with Grade 1 totaling 77 (87.5%) and Grade 2 with a total of 8 (9.1%), followed by diarrhea with Grade 1 totaling 61 (69.3%) and Grade 2 with a total number of 8. (9.1%). There is no data on research subjects with toxicity events in Grade 3 or 4. The results also show that the highest incidence of skin rash in Exon 19 Del with Grade 1 is 48 (54.5%), while in Exon 21 L858R, the number is 29 (33.3%). There is no significant difference between variables where p-value > 0.05. Based on the incidence of toxicity in subjects receiving the EGFR-TKI type, it was found that the incidence of skin rash was most common in the Gefitinib group with Grade 1 numbering 72 (81.8%), while in Erlotinib with Grade 1, the number was 5 (5.7%). Furthermore, the second-highest incidence of diarrhea was in the Gefitinib group with Grade 1, 58 (65.9%), while Erlotinib with Grade 1 was 3 (3.4%). The highest incidence of paronychia in Gefitinib with Grade 1 was 49 (55.7%), while Erlotinib with Grade 1 was 4 (4.5%). Moreover, the incidence of liver function disorders in this study was the highest in Gefitinib with Grade 1 numbering 27 (30.7%), while in Erlotinib with Grade 1, the number was 3 (3.4%). There was a significant difference in the administration of EGFR-TKI with the incidence of diarrheal toxicity in research subjects with a p-value < 0.05, which is 0.010.
Conclusion: The results of this study indicate that the highest incidence of toxicity is skin rash and diarrhea with grade 1 toxicity. No grade 3 or 4 toxicity was found in the study subjects. The incidence of toxicity was also higher in the exon 19 Del mutation group than the exon 21 L858R mutation, although this difference was not statistically significant. This result is in line with several previous studies that have been carried out. | en_US |
