Supplementary Material for: An Improvement of exertional dyspnea by the re-introduction of anti-EGFR antibody in patients with metastatic rectal cancer who developed cancerous lymphangiopathy: A case report

Introduction: Re-exposure to anti-EGFR antibodies, such as re-introduction or re-challenge with anti-EGFR antibodies, has attracted much attention in metastatic colorectal cancer. Re-introduction of anti-EGFR antibodies often shows good therapeutic outcomes, as most patients eligible for re-introduction discontinued treatment due to adverse events despite a good treatment response at front-line treatment. We herein report a case of improvement in exertional dyspnea by re-introduction of anti-EGFR antibody in a patient with metastatic rectal cancer who developed cancerous lymphangiopathy. Case presentation: A 68-year-old man who underwent curative surgery for stage IIIB rectal cancer was diagnosed with multiple lung metastases. During late-line treatment, respiratory failure developed due to multiple lung metastases and cancerous lymphangiopathy. Two months after the initiation of irinotecan+cetuximab, which had been discontinued due to acneiform eruptions despite a good treatment response at first-line treatment, his dyspnea and performance status were dramatically improved. Conclusion: This case indicates that re-introduction of anti-EGFR antibody to patients who have discontinued anti-EGFR antibody due to skin toxicity despite a good treatment response is a very useful treatment option for metastatic colorectal cancer.

引言：再次使用抗表皮生长因子受体抗体（anti-EGFR antibodies）——例如再次给药或再挑战治疗抗表皮生长因子受体抗体——在转移性结直肠癌（metastatic colorectal cancer）领域已受到广泛关注。多数符合再次给药指征的患者，尽管一线治疗期间疗效良好，但因不良事件中断了治疗，而抗表皮生长因子受体抗体的再次给药通常可取得良好的治疗效果。本文报告1例转移性直肠癌患者，其并发癌性淋巴管病，在中断抗表皮生长因子受体抗体治疗后，通过再次给药该类抗体使劳力性呼吸困难得到显著改善。

病例报告：患者为68岁男性，曾因IIIB期直肠癌接受根治性手术，后续确诊多发性肺转移瘤。在后线治疗期间，患者因多发性肺转移瘤及癌性淋巴管病出现呼吸衰竭。该患者一线治疗期间疗效良好，但因痤疮样皮疹中断了伊立替康联合西妥昔单抗治疗；在治疗中断2个月后，其呼吸困难及体力状况评分得到显著改善。

结论：本病例表明，对于一线治疗疗效良好但因皮肤毒性中断抗表皮生长因子受体抗体治疗的转移性结直肠癌患者，再次给予抗表皮生长因子受体抗体是极具临床应用价值的治疗选择。