嚴重味覺改變－辣味覺喪失，罕見enzalutamide治療副作用：病例報告
江佩璋、陳進利、李蕎青、周孟翰、吳勝堂
三軍總醫院 外科部 泌尿外科
Severe dysgeusia - loss of taste of spicy, a rare adverse effect of enzalutamide: first case report in Taiwan
Pei-Jhang Chiang, Chin-Li Chen, Chiao-Ching Li, Meng-han Chou, Sheng-Tang Wu
Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
Introduction:
Enzalutamide is a second-generation oral androgen receptor antagonist approved for patients with metastatic castration-resistant prostate cancer (mCRPC) by the Food and Drug Administration (FDA). Compared with intravenous chemotherapeutic agents, enzalutamide exposure was not associated increased risk of hospitalization or emergency room visits to manage treatment-related complications.
However, there were still some severe adverse effect of enzalutamide which lead patient to discontinue treatment. Common adverse effects of enzalutamide are fatigue, arthralgia, diarrhea, hot flashes, musculoskeletal pain, peripheral edema, and hypertension. Only Few patients (0.1%) suffered from Grade 3-4 adverse effect of dysgeusia in a phase III study.
Case Report:
We present a 64-year-old Taiwanese, mCRPC, chemotherapy-naive patient, who developed grade 1 dysgeusia after taking enzalutamide for 3 months, and grade 3-4 dysgeusia - complete loss of taste of spicy (facing heaven pepper, ‘Chao Tian Jiao’, 30,000-50,000 Scoville heat units) at the 4th month. The patient discontinued enzalutamide and the symptom of dysgeusia got recovery spontaneously 2 weeks later. Thus, the patient shift from enzalutamide to abiraterone for the following treatment. Decreasing serum prostate specific antigen (PSA) and bone scan showed stable disease at present.
Conclusion:
Severe dysgeusia and lose of taste of spicy as an adverse effect of enzalutamide that has not been reported in Taiwan to our knowledge. Physicians should be aware of this reversible adverse effect because it has a considerable effect on quality of life.