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Esophago-tracheobronchial fistula induced by anlotinib: A case report
Yiheng Qian1, Jiabin Qian, Xin Lv
1Department of Pulmonary Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.
Rationale:
Anlotinib is a novel multi-target tyrosine kinase inhibitor (TKI) that targets tumor angiogenesis and proliferation signals, demonstrating significant antiangiogenic effects. It is used as a third-line treatment for refractory advanced non-small cell lung cancer.
Patient Concerns:
An elderly male patient with lung squamous cell carcinoma, who was intolerant to chemotherapy, received anlotinib for antitumor treatment and experienced choking when eating and drinking.
Diagnoses:
Pulmonary computed tomography revealed an irregular cavity adjacent to the mediastinum in the right lung, measuring ~75 mm × 49 mm. Endoscopic examination combined with gastroscopy and tracheoscopy under general anesthesia showed erosion of the carina, absence of the right side, and an ~3-cm-long, oval-shaped esophagotracheal fistula located 26 to 29 cm from the incisors.
Interventions:
A partially covered esophageal stent was placed endoscopically.
Outcomes:
During the 6-month follow-up period, the patient's esophagotracheal fistula narrowed, and he no longer experienced choking while eating or drinking.
Lessons:
The incidence of adverse reactions to anlotinib is relatively low, and esophago-tracheobronchial fistula caused by it is even rarer. When using anlotinib to treat non-small cell lung cancer, clinicians need to monitor changes in patients' symptoms closely. If symptoms of choking when eating and drinking occur, pulmonary computed tomography should be promptly repeated to detect signs of esophago-tracheobronchial fistula early and intervene promptly.
Insights
Anlotinib, a cancer drug, rarely caused an esophagotracheal fistula in a lung cancer patient. Prompt diagnosis and stenting resolved choking symptoms, highlighting the need for vigilant monitoring during treatment.
Area of Science:
- Oncology
- Medical Imaging
- Gastroenterology
Background:
- Anlotinib is a multi-target tyrosine kinase inhibitor (TKI) targeting tumor angiogenesis and proliferation.
- It is utilized as a third-line therapy for advanced non-small cell lung cancer (NSCLC).
Purpose of the Study:
- To report a rare adverse event of anlotinib treatment: esophagotracheal fistula.
- To emphasize the importance of early detection and intervention for this complication.
Main Methods:
- A patient with lung squamous cell carcinoma, intolerant to chemotherapy, received anlotinib.
- Diagnostic procedures included pulmonary CT, gastroscopy, and tracheoscopy.
- An endoscopic partially covered esophageal stent was placed.
Main Results:
- The patient developed an esophagotracheal fistula, presenting as choking during eating and drinking.
- Following stent placement, the fistula narrowed over 6 months.
- The patient's choking symptoms resolved.
Conclusions:
- Esophagotracheal fistula is a rare but serious adverse event associated with anlotinib.
- Close monitoring for symptoms like choking is crucial during anlotinib therapy for NSCLC.
- Prompt diagnostic imaging and endoscopic intervention can effectively manage this complication.
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