Hemorrhage of a pancreatic metastasis from lung adenocarcinoma after osimertinib therapy

Hayasaka, Kazuki; Shiono, Satoshi; Yanagawa, Naoki; Yarimizu, Kei; Suzuki, Katsuyuki; Endoh, Masao

doi:10.21037/jtd.2018.08.108

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…7 Extrathoracic metastases are widely found in the bones, brain, liver, and adrenal glands. 8,9 Pancreatic metastases from lung adenocarcinoma have also been reported before, [10][11][12][13][14][15] but the pancreatic lesions in most cases were presented as synchronous metastases. Heterochronous metastases in the pancreas, which were relatively rare, might be easily confused with primary pancreatic malignancy since adenocarcinoma is also a mainstream phenotype of pancreatic carcinoma.…”

Section: Discussionmentioning

confidence: 78%

Heterochronous Metastases of Lung Adenocarcinoma to Pancreas and Liver: A Case Report from Pathological Perspectives

Zhang

et al. 2021

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Immunohistochemistry (IHC) is a vital tool to distinguish tumor metastases from primary lesions in addition to morphologic analysis. In this study, a 64-year-old female with a past surgical history of lung adenocarcinoma 11 years ago was presented with recurrence of liver nodular lesions after multiple surgical procedures, including the Whipple procedure for pancreatic head adenocarcinoma and cytoreductive surgery for liver metastasis. Liver biopsy and review of the previous specimens, based on IHC analyses, suggested heterochronous metastases of lung adenocarcinoma to the digestive systems in a long-time span, instead of primary pancreatic adenocarcinoma. This case demonstrates the potential for misdiagnoses from morphologic analysis alone and suggests the necessity of IHC analyses to avoid misjudgment on tumor phenotypes, when a previous oncologic history is presented.

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Section: Discussionmentioning

confidence: 78%

Heterochronous Metastases of Lung Adenocarcinoma to Pancreas and Liver: A Case Report from Pathological Perspectives

Zhang

et al. 2021

OTT

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“…In 2018 Kazuki Hayasaka, a scientist from Japan, reported 1 case of papilla of Vater bleeding after Osimertinib treatment for pancreatic metastases from lung adenocarcinoma, but there was no further analysis of the possible causes. 16 In 2013 Bai H, a scientist from China, reported 1 case of Erlotinib and gefitinib treatments result in gastrointestinal bleeding. 13 However, to date there have been no reports of Osimertinib being associated with gastrointestinal bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…However, to date, no studies have been reported in which Osimertinib was associated with gastrointestinal bleeding. [10][11][12] The only drugs used for gastrointestinal bleeding associated with EGFR-TKI were Erlotinib and gefitinib. 13 Here we report a case of advanced NSCLC with diffuse colonic mucosal bleeding detected by colonoscopy after 1.5 years of Osimertinib treatment.…”

Section: Introductionmentioning

confidence: 99%

Colonic mucosal diffuse congestion associated with Osimertinib

Ren

Lei

Cheng

et al. 2023

J Oncol Pharm Pract

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Introduction Non-small cell lung cancer (NSCLC) is the most common histological subtype of lung cancer. Osimertinib has been recommended as first-line treatment of advanced NSCLC with EGFR mutations. Previous studies have only reported cases of gastrointestinal bleeding due to Erlotinib and gefitinib, but to date, always no cases of gastrointestinal bleeding due to Osimertinib have been reported. Case Report We report a case of a female patient with NSCLC with EFGR mutation. After 1.5 years of treatment with Osimertinib, a colonoscopy showed diffuse congestion of the colonic mucosa. Management and Outcome The patient’s symptoms of blood in the stool disappeared, after stopping Osimertinib and giving mucosal protection treatment for 1 week. Discussion Osimertinib may have contributed to gastrointestinal bleeding because no recurrent bleeding was observed after discontinuation of treatment. Physicians and patients should be aware that osimertinib may increase the risk of gastrointestinal bleeding.

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“…Osimertinib might increase bleeding risk at metastatic sites of malignancy. Diffuse alveolar haemorrhage ( Forte and Sangani, 2019 ), subdural haemorrhage ( Yu et al, 2021 ) and metastatic pancreatic haemorrhage ( Hayasaka et al, 2018 ) have been previously reported. No case of intestinal haemorrhage was previously reported.…”

Section: Disscussionmentioning

confidence: 97%

Intestinal Haemorrhage and Colitis Induced by Treatment With Osimertinib for Non-Small-Cell Lung Carcinoma: A Case Report

et al. 2022

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Background: Osimertinib is recommended either as the first-line therapy for sensitizing EGFR-mutations (FLAURA trial) or at progression to first-/second-generation EGFR inhibitors in the presence of resistance mutation T790M (AURA 3 study). It can effectively improve the prognosis of patients with NSCLC with manageable adverse reactions. Among adverse events, intestinal haemorrhage is rare and requires extensive study on its potential lethality.Case presentation: A 59-year-old female, diagnosed with relapsed stage IV (cT4N2M1c) NSCLC with T790M mutation of the EGFR gene, received osimertinib treatment. Eight months after osimertinib treatment, she complained of lower abdominal pain and haematochezia without haemorrhoids. Potential causes of intestinal haemorrhage other than osimertinib toxicity were ruled out. Colonoscopy examination showed severe colitis with grade 3 CTCAE. Osimertinib was discontinued, and prednisone 0.5 mg/kg was administered. Follow-up endoscopy showed no pathological findings. A novel third-generation EGFR-TKI, aumolertinib, was administrated. Five months after aumolertinib initiation, CT evaluation showed stable disease (SD), and this patient was free of colitis recurrence.Conclusion: To our knowledge, this is the first case report of severe colitis as an adverse event associated with osimertinib. Although osimertinib is the standard treatment for NSCLC in patients with T790M mutation and has fewer side effects, colitis may occur after months of treatment. Aumolertinib, a novel third-generation EGFR-TKI, might be an effective alternative for the treatment of patients with NSCLC experiencing colitis from osimertinib.

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Hemorrhage of a pancreatic metastasis from lung adenocarcinoma after osimertinib therapy

Abstract: Figure 1 Chest computed tomography (CT) at the time when the patient was referred to our hospital. CT showed a solitary 2.2 cm lung nodule in the right upper lobe.

Cited by 5 publications

References 15 publications

Heterochronous Metastases of Lung Adenocarcinoma to Pancreas and Liver: A Case Report from Pathological Perspectives

Heterochronous Metastases of Lung Adenocarcinoma to Pancreas and Liver: A Case Report from Pathological Perspectives

Colonic mucosal diffuse congestion associated with Osimertinib

Intestinal Haemorrhage and Colitis Induced by Treatment With Osimertinib for Non-Small-Cell Lung Carcinoma: A Case Report

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