Cancer Res Treat.  2019 Jan;51(1):169-177. 10.4143/crt.2017.491.

The Risk of Herpes Zoster in Patients with Non-small Cell Lung Cancer according to Chemotherapy Regimens: Tyrosine Kinase Inhibitors versus Cytotoxic Chemotherapy

• Choi JY
• Kim M
• Keam B
• Kim TM
• Kim DW
• Heo DS
• Jo SJ

• KMID: 2437610
• DOI: http://doi.org/10.4143/crt.2017.491

Abstract

PURPOSE
Despite the successful use of tyrosine kinase inhibitors (TKIs) in cancer patients, their effect on herpes zoster development has not been studied. The aim of this study was to evaluate and compare the effects of epidermal growth factor receptor (EGFR) TKI and cytotoxic chemotherapy on the risk of herpes zoster development in non-small cell lung cancer (NSCLC) patients.
MATERIALS AND METHODS
We conducted a medical review of all eligible NSCLC patients in Seoul National University hospital between 2002 and 2015. We classified patients based on whether they previously underwent EGFR TKI therapy into either the TKI group or the cytotoxic group. We compared the incidence rates of herpes zoster during TKI therapy and cytotoxic chemotherapy. Additionally, the longitudinal risk of herpes zoster from TKIs was analyzed using the incidence rate ratio (IRR) of the TKI group to the cytotoxic group and the log-rank test of the Kaplan-Meier method.
RESULTS
Of the 2,981 NSCLC patients, 54 patients (1.54%) developed herpes zoster. In the TKI group (2,002 patients), the IRR of herpes zoster during TKI therapy compared to that during cytotoxic chemotherapy was 1.05 (95% confidence interval [CI], 0.53 to 2.09). The IRR of the TKI group compared to the cytotoxic group was 1.33 (95% CI, 0.64 to 2.76). The Kaplan-Meier cumulative risk of both groups was not significantly different.
CONCLUSION
Our results show that the incidence rate of herpes zoster in the TKI group was not statistically different from the incidence in the cytotoxic group during and after chemotherapy in NSCLC patients.

Keyword

Herpes zoster; Epidermal growth factor receptor; Cytotoxic chemotherapy; Non-small-cell lung carcinoma; Gefitinib; Erlotinib

MeSH Terms

Carcinoma, Non-Small-Cell Lung*
Drug Therapy*
Erlotinib Hydrochloride
Herpes Zoster*
Humans
Incidence
Methods
Protein-Tyrosine Kinases*
Receptor, Epidermal Growth Factor
Seoul
Tyrosine*
Erlotinib Hydrochloride
Protein-Tyrosine Kinases
Receptor, Epidermal Growth Factor
Tyrosine

Figure

• 

  Fig. 1. Definition of the tyrosine kinase inhibitor (TKI)/cytotoxic regimen period and the TKI/cytotoxic groups. (A) The TKI regimen period was defined as the total treatment period treated with epidermal growth factor receptor (EGFR) TKI and the cytotoxic regimen period was defined as the total period treated with cytotoxic chemotherapy. (B) The TKI group was defined as the patients who had received at least one course of EGFR TKI and the cytotoxic group was defined as the patients who had received the cytotoxic-regimen only. The incidence of herpes zoster that occurred after the initiation of the first chemotherapy was included in the study.

• 

  Fig. 2. The Kaplan-Meier cumulative incidence of herpes zoster plotted to compare the tyrosine kinase inhibitor (TKI) group and cytotoxic group (A), gefitinib group and cytotoxic group (B), and erlotinib group and cytotoxic group (C).

Reference

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