In addition to the familiar adverse effects of targeted drugs for lung cancer, there are also some more serious adverse effects that are related to the individual’s body type. The risk of these reactions is low, but when they do occur, they can be serious. Here is a brief overview of these reactions, so please pay attention to them during the course of your medication and communicate with your doctor if you are uncomfortable.
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I. Interstitial pneumonia
Be on the lookout for this rare but serious adverse reaction if you have had dyspnea in the past, or if you have had it in the past, but it gets worse while you are taking the drug, or if you have unexplained cough, shortness of breath, or other respiratory symptoms.
Once symptoms appear, the situation is often already more serious. How can it be detected earlier? During anti-tumor treatment, your doctor will ask you to review your CT regularly, but when you have these symptoms, you don’t need to wait until the “right moment” to do so, you should talk to your doctor and review the tests in advance so that your doctor can provide you with targeted treatment.
Once the diagnosis of interstitial pneumonia caused by a targeted drug is confirmed, your doctor will manage it promptly and aggressively, usually by discontinuing the “offending” drug, using glucocorticosteroids for anti-inflammation, supplemental ventilation, and reducing fluid intake.
II. Cardiotoxicity
One class of targeted agents commonly used to treat lung cancer, EGFR-TKI (the technical name is “epidermal growth factor receptor tyrosine kinase inhibitor”), such as gefitinib, may cause cardiotoxicity, but it is relatively rare. Another targeted drug, ALK-TKI (known as “mesenchymal lymphoma kinase inhibitor”), such as crizotinib, can also affect cardiac function, causing bradycardia and prolonged QT intervals on the electrocardiogram. The main causes of QT interval prolongation are The main risk of a prolonged QT interval is that it can lead to a specific type of tachycardia – tip-twisting ventricular tachycardia – in which patients experience brief (seconds to minutes) weakness, debility, and even fainting.
Because of this, your doctor may recommend that you have an electrocardiogram before and during the start of targeted drug therapy. Your doctor will also monitor the electrolyte levels in your blood (e.g., sodium, potassium, etc.). If you experience unexplained weakness or fainting during treatment, let your doctor know and he or she may investigate the drug’s toxicity to your heart or even call in a cardiologist.
III. Hepatitis B virus activation
China is a “hepatitis B country,” and some lung cancer patients also have the hepatitis B virus. In this case, the hepatitis B virus, which had been under control, may be reactivated due to the impact on the immune system, which may aggravate the damage to liver function and even lead to liver failure.
So, before receiving molecularly targeted therapy, your doctor may check for indicators of hepatitis B virus, quantify the virus if you have it, and continue to take antiviral drugs such as entecavir during targeted therapy.
IV. Kidney damage
Normal human kidney tissue also has expression of EGFR (epidermal growth factor receptor) and VEGF (vascular endothelial growth factor), which are involved in normal intracellular signaling and maintain the normal structure and function of the glomerulus and tubules. The first time I saw this, I was able to get to the top of the list, and I was able to get to the bottom of the list.
This is when kidney damage can occur, from protein in the urine and abnormal kidney function indicators in the blood to kidney failure in severe cases. Therefore, during the course of treatment, the doctor will also require regular rechecking of renal function indicators to monitor the patient’s condition and, if needed, add a routine urine test, through which protein can be detected if it appears in the urine.
In summary, targeted therapies may produce some rare and easily overlooked adverse effects, but they are not untraceable and can be detected early and managed promptly with some monitoring and attention to related symptoms. What you need to do is not to worry too much, because the probability of their occurrence is relatively low; secondly, please do not overlook your own health condition, although these adverse reactions are relatively rare, but relatively serious. Therefore, once discovered, please seek immediate medical attention and cooperate with your doctor’s examination and treatment.
Co-reviewed by: Dr. Qing Zhou, Chief Physician, Guangdong Provincial People’s Hospital, Guangdong Lung Cancer Institute Dr. Xiaoyan Bai Dr. Xin Gao