학술논문
Successful Rechallenge with Osimertinib after Very Acute Onset of Drug-Induced Pneumonitis
Document Type
Clinical report
Source
Case Reports in Oncology. May 2021, Vol. 14 Issue 2, p733, 6 p.
Subject
Language
English
Abstract
Author(s): Turab Mohammed [a]; Shaunak Mangeshkar [b]; Joerg Rathmann [c] Introduction Targeted therapy against epidermal growth factor receptor (EGFR) driver mutations, the most frequently documented gene mutation in non-small cell [...]
Drug-induced interstitial lung disease (DI-ILD) is a rare, yet life-threatening complication associated with tyrosine-kinase inhibitor (TKI) therapy. Third-generation epidermal growth factor receptor-TKI, osimertinib use can be associated with a benign radiological finding called transient asymptomatic pulmonary opacities that can be confused with an infectious pulmonary process resulting in overtreatment with antibiotics or premature treatment withdrawal or severe DI-ILD. In this case, our patient with newly diagnosed metastatic non-small cell lung cancer on treatment with osimertinib developed very early onset severe DI-ILD (grade-IV) with a unique pattern of pulmonary involvement and was treated with high-dose corticosteroids with a response. She was later successfully rechallenged with osimertinib and responded well to the treatment. Our case highlights the importance of being cognizant of the possibility that DI-ILD can rarely occur within a week of treatment initiation with osimertinib and safe reintroduction of the drug is possible in select patients following complete resolution of pulmonary radiographic findings and clinical symptoms even with high-grade adverse events. Keywords: Osimertinib, Drug-induced pneumonitis, Drug-induced ILD, Transient asymptomatic pulmonary opacities, Non-small cell lung cancer
Drug-induced interstitial lung disease (DI-ILD) is a rare, yet life-threatening complication associated with tyrosine-kinase inhibitor (TKI) therapy. Third-generation epidermal growth factor receptor-TKI, osimertinib use can be associated with a benign radiological finding called transient asymptomatic pulmonary opacities that can be confused with an infectious pulmonary process resulting in overtreatment with antibiotics or premature treatment withdrawal or severe DI-ILD. In this case, our patient with newly diagnosed metastatic non-small cell lung cancer on treatment with osimertinib developed very early onset severe DI-ILD (grade-IV) with a unique pattern of pulmonary involvement and was treated with high-dose corticosteroids with a response. She was later successfully rechallenged with osimertinib and responded well to the treatment. Our case highlights the importance of being cognizant of the possibility that DI-ILD can rarely occur within a week of treatment initiation with osimertinib and safe reintroduction of the drug is possible in select patients following complete resolution of pulmonary radiographic findings and clinical symptoms even with high-grade adverse events. Keywords: Osimertinib, Drug-induced pneumonitis, Drug-induced ILD, Transient asymptomatic pulmonary opacities, Non-small cell lung cancer