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.