Objective

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To explore characteristics of traditional Chinese medicine （TCM） syndromes of syndromes of epidermal growth factor receptor tyrosine kinase inhibitors （EGFR-TKIs）-related rash based on latent class analysis.

Methods

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We included 123 non-small cell lung cancer patients with EGFR-TKIs-related rash in the study. The general data and the appearance of the rash including the shape， color， luster， and exudation of the skin lesion， deficiency and excess， and other symptoms such as pruritus and pain were collected. EGFR-TKIs were grouped into first generation （gefitinib， erlotinib， icotinib）， second generation （afatinib， dacomitinib）， and third generation （osimertinib）. Latent class analysis was used to analyze the data on the appearance of the rash， including model parameterization， parameter estimation， model identification， model evaluation， latent classification， and interpretation of results.

Results

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Totally， 123 patients （63 male and 60 female） were included. The number of cases treated by first， second and third generation of EGFR-TKIs was 52， 57 and 14， respectively， and significant difference in gene types was found among the groups （

P

＜0.05）. There were statistically significant differences in the proportion of papules with exudate， blisters， damp heat， blood deficiency with phlegm， and itching due to damp among patients using different generations of EGFR-TKIs （

P

＜0.05）. Latent class analysis showed that when the number of latent classes is 3， the Bayesian Information Criterion （BIC） is smallest （BIC=3657.74）， and the model of three latent classes is considered to be an relatively ideal one based on the clinical experience. Judged with syndrome differentiation， classⅠ corresponds to

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deficiency and internal heat syndrome， while classⅡ and Ⅲ correspond to damp-heat-phlegm retention syndrome， and lung channel wind-heat syndrome， respectively. Calculated by posterior probability， 123 patients were grouped into 43 cases of class I （35%）， 45 cases of classⅡ（36.6%）， and 35 cases of classⅢ （28.5%）. For patients treated by the first generation of EGFR-TKIs，

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deficiency and internal heat syndrome and lung channel wind-heat syndrome were mostly common （32.69% and 38.46%）；

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deficiency and internal heat syndrome and damp-heat-phlegm retention syndrome were the most common types among people treated by second generation of EGFR-TKIs （40.35% and 35.09%）， while damp-heat-phlegm retention syndrome was mostly seen in those given third generation of EGFR-TKIs （71.43%）.

Conclusion

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Three common types of EGFR-TKIs-related rash are

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deficiency and internal heat syndrome， damp-heat-phlegm retention syndrome， and lung channel wind-heat syndrome.