Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKI) are new drugs for the treatment of advanced non-small cell lung cancer in recent years, commonly represented by gefitinib and erlotinib. For advanced non-small cell lung cancer with epidermal growth factor receptor (EGFR) mutation first-line treatment objective remission rate can reach more than 70% [1], so it is now approved as the first-line treatment for patients with EGFR mutation. However, the incidence of its most common adverse effects dermatotoxicity is as high as 41, 4%-95% [2-3], which affects the quality of life of patients and in severe cases leads to drug reduction or even discontinuation of treatment. The author’s unit uses Chinese medicine to treat rashes caused by EGFR-TKI with good efficacy. My experience in using Chinese medicine to treat rashes related to EGFR-TKI is summarized as follows.
1. Etiology and pathogenesis
According to Chinese medicine, this disease belongs to the category of “Chinese medicine poison” and “medicine poison rash”, which occurs because the patient’s innate endowment is not resistant and suffers from internal invasion of medicine poison, resulting in wind, heat and dampness poison stagnating in the skin couples. If the patient is endowed with a blood-heat body and suffers from drug toxicity, the blood-heat and toxicity will be congested in the skin, resulting in a blood-heat rash with red spots as the main evidence. If a damp-heat endowed body suffers from drug toxicity, it will lead to damp-heat entrapped toxicity congestion in the skin, resulting in a damp-heat rash and blisters. If the drug toxicity is severe, spots, blisters and blisters will occur on the external skin, and internal invasion of the internal organs will result in the evidence of burnt qi and ying. In the later stage, the symptoms will subside, because the fever hurts the yin and consumes the qi, so it shows the evidence of heat and injury to yin.
2.Cognitive evidence and treatment
2.1 Toxic-heat and wind type
Main evidence: the onset of the disease is urgent, mostly on the head and face, upper limbs and chest and abdomen, mostly wind masses, erythema, papules, itching, accompanied by nausea, fever, headache, red tongue, thin yellow coating, floating pulse.
Treatment: Eliminating wind and clearing heat, cooling the blood and detoxifying the toxin.
Main formula: Add reduction to eliminate wind and heat.
2.2 Damp-heat congestion type
Main symptoms: papular rash, blisters, exudation, vesicles, itching, dry mouth, bitter mouth, or fever, dry stool or foul smell, yellow urine, red tongue, yellow greasy coating, slippery pulse.
Treatment: Clearing heat and cooling the blood, detoxifying and dispelling dampness.
Main formula: Gentian-Diarrhea Liver Soup with addition and subtraction.
2.3 Blood-heat and spotting type
Main manifestations: widespread pustular acne-like rash with bright red or deep red rash, burning and itching skin, purple skin color, dry mouth without desire to drink, dry stool, short and red urine, red and vivid tongue, little fur, and fine pulse.
Treatment: Clearing heat and cooling the blood, detoxifying and resolving blood stasis.
Main formula: Hepatite Tang with reduction.
2.4 Qi and Yin deficiency type
Main symptoms: Mostly seen in the late stage, the rash tends to fade away, or scales fall off, itchy and heavy, especially at night, fatigue and weakness, dry mouth and drinking, red tongue, little coating, fine pulse.
Treatment: Benefiting Qi and nourishing Yin, supporting Zheng and detoxifying.
Main formula: Benefit the stomach and add reduction.
3.Pay attention to external treatment method
The “Rational Boiling Encyclopedia” says: “The theory of external treatment is the theory of internal treatment, and the medicine of external treatment is also the medicine of internal treatment, but the difference is the method. The external application of drugs on the surface of the body allows the drugs to penetrate the skin and hair couples and reach the internal organs, adjusting the balance of yin and yang of the body and achieving the purpose of treatment. For rashes caused by EGFR-TKI, topical drugs can reach the disease directly and work quickly, which is more advantageous than the internal treatment method. The author’s self-designed formula for clearing heat and eliminating rash is often effective when applied externally, specifically: 30 g of honeysuckle, 30 g of dandelion, 30 g of comfrey, 30 g of mullein, 30 g of bupleurum, 30 g of bitter ginseng, 15 g of osmanthus, 30 g of salvia, 20 g of red peony, 30 g of Xu Changqing, and 30 g of wei lingxian. Add 1500mL of water, soak for 60min, decoct to 1000mL, then filter the juice and let it cool down to the appropriate temperature for 30min, and wash externally twice a day. Commonly used topical medications are also Thornbush, Wild Chrysanthemum, Serpentine, Phellodendron, Phellodendron, Scutellaria, Tribulus terrestris, Paeonia, etc.
3, pay attention to food therapy
Food therapy is the abbreviation of diet therapy, also known as food therapy, food medicine, food nutrition, medicinal food, etc.. Usually referred to as food therapy, refers to the application of food through the diet route from the mouth into the abdomen and achieve the purpose of disease prevention and treatment. Ancestral medicine believes that “medicine and food have the same origin”, and has always attached importance to the role of diet in the process of disease development until. For example, Zhang Xichen’s “Medicine in the heart of the West” cloud: “patients take it, not only to cure the disease, and can fill the hunger, but also can be suitable for the mouth, with the right symptoms, the disease since the gradual healing, even if not the right symptoms, there are no other problems.” If a patient with lung cancer has a rash while taking EGFR-TKI, the diet should be light and easy to digest. Commonly used dietary recipes include soybean and bitter gourd rib soup, red silk thread stewed lean pork soup, turtle stewed soup with Tu Fu Ling, and thatch root and Zhi Mu dendrobium drink. Prohibit fatty, fried, spicy food, such as try to avoid shrimp, crab, beef, mutton, onion, ginger, garlic, leek, pepper, chili and other hairy and irritating food. 4, case introduction
Chen Moumou, female, 43 years old, visited the clinic in November 2011 with “recurrent cough for 2 months”, and a CT scan of the chest and abdomen showed that peripheral lung cancer in the right upper lung with multiple metastases in the right hilum, mediastinal lymph nodes and liver. The pathological results of percutaneous lung puncture biopsy showed: hypofractionated adenocarcinoma (right lung) and EGFR test showed: exon 21 mutation. On November 26, 2011, he started to take Gefitinib 250mg qd orally. 1 week after taking the drug, the patient started to develop a rash, which was not taken seriously at first, but later the symptoms gradually worsened. The patient’s symptoms were: clear, good spirits, little cough and sputum, dry mouth and bitterness, widespread acne-like rash all over the body, partly with pus spots and vesicles, unbearable itching, inability to sleep, bad breath, dry mouth and bitterness, dry stools, yellow and red urine, red tongue, yellow and greasy coating, and slippery pulse. The patient felt painful and had stopped gefitinib on his own. Diagnosis 1, lung accumulation; 2, drug toxicity rash. The diagnosis was damp-heat congestion type. The rash was graded as grade 3 according to CTCAE 3, 0. The treatment was based on clearing heat and cooling blood, detoxifying and dispelling dampness. Gentian and liver diarrhea Tang is added and reduced with the following herbs: 6 grams of gentian herb, 12 grams of scutellaria, 9 grams of mountain gardenia, 15 grams of zedoary, 15 grams of mouton, 15 grams of psyllium, 15 grams of angelica, 30 grams of raw groundnut, 15 grams of chai hu, 15 grams of bitter ginseng, 30 grams of adzuki bean, 30 grams of fu ling, and 6 grams of raw licorice. The above formula is taken with water decoction, one dose daily. In addition, we also gave the formula of clearing heat and eliminating rash plus reduction of external washing, specific drugs: 30 grams of honeysuckle, 30 grams of dandelion, 30 grams of comfrey, 30 grams of mullein, 30 grams of bupleurum, 30 grams of bitter ginseng, 30 grams of salvia, 20 grams of red peony, 30 grams of Xu Changqing, 30 grams of yellow cypress, 15 grams of snake bed seed. One dose daily, divided into 2 times for external washing. After 3 days of treatment, the patient’s rash improved significantly, the color became lighter, some of the erosion and pus spots were obviously converged, the itching was relieved, and he was able to sleep. The dryness of the mouth and bitterness of the mouth were alleviated, the stool was passed, the urine was slightly yellow, the tongue was red, the coating was yellow, and the pulse was smooth. Considering that the treatment was effective, after 1 week of continuous use of the above method, the patient’s rash had significantly turned darker and lighter, no itching, and the symptoms were basically relieved, with a slightly red tongue, yellowish coating, and smooth pulse. The patient was instructed to continue to take Gefitinib, and continued with the above method for two weeks during the medication period, and no significant new rash appeared.