A Systematic Review of Replacing Tyrosine Kinase Inhibitors with Similar Drugs After Liver Injury
10.3870/j.issn.1004-0781.2025.02.014
- VernacularTitle:酪氨酸激酶抑制剂致肝损伤后替换为同类药物的系统评价
- Author:
Ya CHEN
1
;
Chao LI
;
Xue MA
;
Ting YU
;
Yue QIU
;
Na LI
Author Information
1. 四川省肿瘤临床医学研究中心,四川省肿瘤医院·研究所,四川省癌症防治中心,电子科技大学附属肿瘤医院药学部,成都 610041
- Publication Type:Journal Article
- Keywords:
Tyrosine kinase inhibitors;
Epidermal growth factor receptor;
Anaplastic lymphoma kinase;
Multiple targets;
Liver injury
- From:
Herald of Medicine
2025;44(2):259-266
- CountryChina
- Language:Chinese
-
Abstract:
Objective To systematically evaluate the safety and efficacy of replacing tyrosine kinase inhibitors(TKIs)with similar drugs after they cause liver injury,based on case reports and case series studies.Methods PubMed,Embase,Cochrane,Web of Science,CNKI,Wanfang,and VIP databases were searched up to October 2023.Two reviewers independently screened the literature,extracted data,and assessed the quality of the studies.Descriptive and statistical analyses were performed.Results Twenty-six studies(22 case reports and 4 case series)were included,involving 75 patients who switched to similar drugs for TKI-induced liver injury,primarily targeting the epidermal growth factor receptor(EGFR),anaplastic lymphoma kinase(ALK),and multiple targets.The results indicate that majority of patients have favorable safety profiles after switching drugs,with normal liver function or no severe liver injury.Only one patient reported a serious liver adverse reaction,characterized by(grade 3 total bilirubin elevation).In terms of clinical efficacy,most patients responded well to the new TKIs,maintaining stable disease,or showing no progression during follow-up.Disease progression occurred in only two patients who switched from gefitinib to erlotinib after dose reduction due to non-hepatic adverse effects.Additionally,one patient who switched from erlotinib to afatinib experienced worsening tumor symptoms.Conclusion Evidence from published case reports and case series suggests that continuing treatment with similar drugs after TKI-induced liver injury,targeting EGFR,ALK,and multiple targets,demonstrates a certain degree of safety,efficacy,and clinical practicability.This can be a strategy after TKI discontinuation due to liver injury.However,there are no clear guidelines on drug selection,timing,and dosage,and further research is urgently needed.
