학술논문
Brief Report: Risk of Recurrent Interstitial Lung Disease From Osimertinib Versus Erlotinib Rechallenge After Symptomatic Osimertinib-Induced Interstitial Lung Disease
Document Type
article
Author
Molly S.C. Li, M.B.B.S.; Kirsty W.C. Lee, MBChB; Kevin K.S. Mok, MBChB; Herbert H.F. Loong, M.B.B.S.; K.C. Lam, MBChB; Florence S.T. Mok, M.B.B.S.; Landon L. Chan, MBChB; Y.M. Lau, M.B.B.S.; K.P. Chan, MBChB; Joyce T.Y. Ng, MBChB; Wesley K.Y. Wong, M.B.B.S.; Benjamin H.W. Lam, M.B.B.S.; Allen C.C. Chen, BM; Matthew M.P. Lee, MBChB; Olivia H. Chen, MD, PhD; Tony S.K. Mok, MD
Source
JTO Clinical and Research Reports, Vol 5, Iss 4, Pp 100648- (2024)
Subject
Language
English
ISSN
2666-3643
Abstract
Introduction: Interstitial lung disease (ILD) is the most frequent cause of drug-related mortality from EGFR tyrosine kinase inhibitors (TKIs). Yet, for patients with symptomatic osimertinib-induced ILD, the risk of recurrent ILD associated with EGFR TKI rechallenge, either with osimertinib or another TKI, such as erlotinib, is unclear. Methods: Retrospective study of 913 patients who received osimertinib treatment for EGFR mutation-positive NSCLC. Clinical characteristics, ILD treatment history, and subsequent anticancer therapy of patients with symptomatic osimertinib-induced ILD were collated. The primary end point was to compare the incidence of recurrent ILD with osimertinib versus erlotinib rechallenge. Results: Of 913 patients, 35 (3.8%) had symptomatic osimertinib-induced ILD, of which 12 (34%), 15 (43%), and eight (23%) had grade 2, 3 to 4, and 5 ILD, respectively. On ILD recovery, 17 patients had EGFR TKI rechallenge with eight received osimertinib and nine received erlotinib. The risk of recurrent ILD was higher with osimertinib rechallenge than erlotinib (p = 0.0498). Of eight, five (63%) developed recurrent ILD on osimertinib rechallenge, including three patients with fatal outcomes. In contrast, only one of nine patients (11%) treated with erlotinib had recurrent ILD. Median time to second ILD occurrence was 4.7 (range 0.7–12) weeks. Median time-to-treatment failure of patients with erlotinib rechallenge was 13.2 months (95% confidence interval: 8.6–15.0). Conclusions: The risk of recurrent ILD was considerably higher with osimertinib rechallenge than erlotinib. Osimertinib rechallenge should be avoided, whereas erlotinib may be considered in patients with symptomatic osimertinib-induced ILD.