Bleeding with gastrointestinal and ureteral ulcers after gefitinib treatment: a case report

Epidermal growth factor receptor (EGFR) inhibitors, as a first-line drug treatment in the EGFR-sensitive mutation of advanced non-small-cell lung cancer (NSCLC), has been used in a wide variety of malignancies. These therapies have various troublesome side effects including diarrhea, stomatitis, mucositis, rash, dry skin and paronychia which may impact a patient's clinical outcome in addition to their beneficial effects. Here, we report a rare case of a 69-year-old male having advanced NCSLC treated with gefitinib, who developed EGFR tyrosine kinase inhibitor (TKI)-related multiple ulcers accompanied by bleeding. After a detailed examination and multidisciplinary discussion, we have learnt that early identification of gastrointestinal (GI) bleeding and blood in urine is due to targeted drugs rather than other causes such as ulcer and stones. Good results have also been achieved by reducing drug dosage under close observation. So far, the patient has been followed up for 15 months, and his condition remained stable. Up to now, there is no case of such severe side effect having been found, and no guidelines recommended for handling such adverse events. Through clinical case sharing, early recognition and proactive management are particularly important in order to minimize appropriately the effect of these adverse events. The whole course of a disease can be vividly illustrated through a case report, so as to provide more effective guiding principles for clinicians.