TITLE:
A Rare Case of Tarceva Resulting in Tympanic Membrane Necrosis
AUTHORS:
Michele M. Gandolfi, Ana H. Kim
KEYWORDS:
Tympanic Membrane Necrosis; Tympanoplasty; Tarceva©
JOURNAL NAME:
International Journal of Otolaryngology and Head & Neck Surgery,
Vol.2 No.4,
July
2,
2013
ABSTRACT: Objective: To report a novel case of Tarceva? treatment for
small cell lung carcinoma resulting in tympanic membrane necrosis. Patient: A 49-year-old male
with tympanic membrane necrosis and presumed resistant acute otitis externa and
chronic inflammation of the left ear. Patient is status post
chemotherapy and radiation diagnosed with non-small cell lung cancer in
December 2008 with on-going therapy with Tarceva? for
residual disease. Intervention: Tympanoplasty
of left ear. Results: Improvement of symptoms of irritation and improvement of hearing
and speech reception thresholds. All acid fast bacilli, fungal and bacterial
cultures of the intra-op specimen were negative. Conclusions: The possibility that long
term Tarceva? therapy could have caused the tympanic
membrane necrosis and acute otitis media like symptoms is feasible since
Tarceva? is an inhibitor of epidermal growth factor receptor
(EGFR) tyrosine kinase. Upon activation of EGFRs it undergoes a transition from
inactive monomeric form to active homodimer or hertodimer with another member
of the ErbB receptor family. This then initiates several signal transduction
cascades, leading to DNA synthesis and cell proliferation. Activation of the
receptor is important in the innate immune response in human skin. Some of the
common side effects include an aceiform skin rash but this is the first
reported link between tympanic membrane necrosis and Tarceva?.