폐암 환자들에서 Gefitinib (Iressa)에 의한 피부 부작용 = Cutaneous Adverse Reactions Induced by Gefitinib (Iressa) in Lung Cancer Patients

국문 초록 (Abstract)

배경: 최근 폐암 환자에서 사용하는 표적치료 항암약물인 gefitinib (Iressa)은 종양세포의 표피성장인자 수용체의 티로신 키나아제 활동을 선택적으로 억제하여 종양 세포의 성장에 관여하는 신호를 차단함으로써 치료효과를 나타낸다. Gefitinib 복용에 의한 피부 부작용으로 여드름양 발진, 피부 건조증, 모발 변화 등이 알려져 있다. 대상 및 방법: 2004년 10월부터 2005년 9월까지 화순전남대병원에서 비소세포 폐암으로 진단받고 gefitinib을 복용 중인 환자들 중 피부 부작용이 발생하여 피부과에 의뢰된 환자 23명을 대상으로 임상 양상을 분석하였다. 결과: 나이는 23-72세였고, 비소세포 폐암의 종류는 선암 17명, 편평상피세포 폐암 5명이었고, 여자 6명, 남자 17명이었다. 가장 흔한 부작용은 여드름양 발진으로 15명(65.2%)에서 발생하였으며, 주로 두피, 얼굴, 가슴, 등 부위에 무증상의 홍반성 구진으로 나타나며 대부분 gefitinib 복용 1달 이내에 발생하였다. 여드름양 발진의 빈도는 gefitinib 치료에 대한 반응과 유의한 상관관계를 보이지 않았고, 조직 형에 따른 차이도 관찰되지 않았다. 피부 소양증은 9명(39.1%)에서 발생하였으며 경도의 전신 소양증이 가장 많았고, 특히 눈 주변의 소양증을 호소하였다. 인설을 동반한 피부 건조증이 6명(26.1%)에서 발생하였고, 손발바닥의 홍반과 표피 박탈이 5명(21.7%), 손톱이나 발톱주변에 조갑주위염이 5명(21.7%)에서 발생하였다. 드물게 모발이 부러지거나 겨드랑이, 오금에 간찰진이 발생하였다. 결론: 본 연구에서 gefitinib에 의한 다양한 피부 부작용들을 관찰할 수 있었다. Gefitinib을 처방하는 의사들은 피부 부작용에 대한 관심이 필요하며 환자들에게 피부 관리에 대한 교육과 필요한 경우 피부과 의사와 함께 피부 부작용을 치료함으로써 부작용을 경감시킬 수 있었다.

다국어 초록 (Multilingual Abstract)

Background: Gefitinib (ZD 1839, Iressa) is a new anticancer agent; more specifically, it is a selective epidermal growth factor receptor tyrosine kinase inhibitor that is, widely used for various solid cancers, including lung cancer. Cutaneous adverse reactions induced by gefitinib have recently been reported; however, not much on this topic has been reported in the Korean literature. Method: We studied cutaneous adverse reactions of gefitinib in 23 patients who suffered with non-small cell lung cancer at Chonnam National University Hwasun Hospital from October 2004 to September 2005. Result: The patients ranged from 23-72 years old, and there were 17 patients with adenocarcinoma, 5 with squamous cell carcinoma and 1 with bronchioloalveolar carcinoma. The most common adverse reaction was acneiform eruptions in 15 patients (65.2%). This reaction appeared within 2 months after medication, and it didn`t correlate with the therapeutic response and tumor type. Pruritus was the second most common reaction (39.1%), which was mild and generalized, especially around eyelid area. Xerosis (26.1%), exfoliation on palm and sole (21.7%), and paronychia (21.7%) followed. Hair breakage and intertrigo were rare adverse reactions. Conclusion: Various cutaneous adverse reactions were observed in patients with non-small cell lung carcinoma after gefitinib treatment. The skin complications could be alleviated with dermatologic consultations and treatments, skin complications could be alleviated. (Tuberc Respir Dis 2006; 61: 150-156)

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