中醫藥治療第四期大腸癌EGFR抑制劑所致皮疹病例報告

A Case Report of Traditional Chinese Medicine Alleviating Skin Rash Subsequent to EGFR Inhibitors

僅管近年來醫療製藥技術有突破性發展，轉移性大腸直腸癌預後仍差。目前主流第一線治療為Epidermal growth factor receptor inhibitor（EGFR抑制劑）Cetuximab合併FOLFIRI治療能有效阻止疾病惡化，特別是對無法手術的肝臟轉移患者有顯著助益。然而研究統計有相當大比例的病患在接受此療法後會產生皮膚相關副作用，這些皮膚不良反應產生機制與EGFR作用的抑制有關，但確切的病理生理學仍有待證實。本病例報告為47歲第四期升結腸大腸癌合併肝臟轉移病患，使用EGFR抑制劑Cetuximab配合FOLFIRI治療，因藥物副作用產生嚴重皮疹，搔癢難忍影響生活品質而求診中醫診治。在服用中藥清熱解毒、養陰清熱藥二個月控制後，皮疹症狀及睡眠品質皆獲得良好改善，病人得以持續接受西醫抗癌療程。我們希望藉由此個案說明中醫藥治療第四期升結腸大腸癌使用EGFR抑制劑治療後副作用皮疹之臨床療效。

The prognosis of metastatic colorectal cancer remains poor despite advances made in recent years. The combination of cetuximab and FOLFIRI is currently the first-line treatment, proven by studies to be the best solution in reducing the risk of progression of metastatic colorectal cancer. Nevertheless, patients who underwent the treatment have a substantial risk of developing high-grade skin rash and other skin-related discomforts. These skin effects appear to be mechanism-based linked to the inhibition of EGFR action but the exact pathophysiology remains elusive. Left untreated these dermatological side-effects could represent a threat to patient compliance and therefore effective management is mandatory. Our study aim to find solution from perspective of Tradition Chinese Medicine. We report a 47-year-old man with metastatic colorectal cancer who suffers from skin rash following concurrent treatment of cetuximab and FOLFIRI. The skin rash seriously exacerbate his quality of life. Thus, he turned himself to traditional Chinese Medicine for a continuous treatment of eight weeks and the discomfort abated. This study endeavor in discussion of the role of Traditional Chinese medicine in resolving side-effects from EGFR inhibitors.