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Japanese Journal of Clinical Oncology Advance Access published online on November 7, 2009
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyp141
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© The Author (2009). Published by Oxford University Press. All rights reserved

Massive Hematuria from the Bilateral Upper Urinary Tract in a Patient Treated for Advanced Lung Cancer with Gefitinib

Hidenori Mori1, Yasushi Ohno1, Fumitaka Ito1, Norihiko Funaguchi1, Komei Yanase1, Junki Endo1, Masahiro Nakano2, Bu Lin Bai La1 and Shinya Minatoguchi1

1 Second Department of Internal Medicine, Gifu University School of Medicine
2 Department of Urology, Gifu University School of Medicine, Gifu, Japan

For reprints and all correspondence: Shinya Minatoguchi, Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Yanagido 1-1, 501-1194 Gifu, Japan. E-mail: minatos{at}gifu-u.ac.jp

Received May 1, 2009; accepted September 23, 2009

We report a case of gefitinib-induced bilateral upper urinary tract bleeding in an 82-year-old woman administered the drug daily for advanced non-small cell adenocarcinoma of the lung (T4N3M0). Hematuria is an uncommon adverse effect of gefitinib, and in most cases, the bleeding site is unknown. On the 44th day of oral gefitinib administration, the patient noted asymptomatic macroscopic bloody urine. Cystoscopy revealed bleeding from the bilateral ureteric orifices without hemorrhagic inflammation of the bladder. One week later, she was admitted complaining of severe abdominal pain, and her condition was found to be complicated by liver damage and renal dysfunction. We stopped gefitinib administration and started hydration and diuresis. Renal function and urine output soon recovered, and at the request of the patient, we restarted gefitinib, administering it every other day, which was sufficient to maintain antitumor activity and stabilize the disease. On the 41st day after restarting gefitinib, hematuria and proteinuria reappeared. We therefore stopped the gefitinib, and the patient was followed with supportive care. The patient's autopsy findings denied organic urologic diseases. Instead, the reproducibility of the hematuria from the upper urinary system strongly suggests an unexpected gefitinib-related adverse effect.

Key Words: gefitinib • hematuria • lung cancer • proteinuria


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