Successful osimertinib retreatment after extremely early onset severe pneumonitis in first‐line treatment of lung adenocarcinoma

Ahn, Jae‐Jun

doi:10.1111/1759-7714.13565

Cited by 4 publications

(3 citation statements)

References 12 publications

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“…Our patient demonstrated very early onset symptom manifestation and her severe grade 3 ILD with unique striking pulmonary findings responded well to high-dose corticosteroids. We could find only one case in the literature where osimertinib-related pulmonary complications occurred within 1 week of treatment initiation [9]. A unique finding in our patient was the presence of pleural effusion, a finding not commonly reported with EGFR TKI-related ILD.…”

Section: Discussion/conclusionmentioning

confidence: 60%

Successful Rechallenge with Osimertinib after Very Acute Onset of Drug-Induced Pneumonitis

Mohammed

Mangeshkar²,

Rathmann

2021

Case Rep Oncol

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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.

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Section: Discussion/conclusionmentioning

confidence: 60%

Successful Rechallenge with Osimertinib after Very Acute Onset of Drug-Induced Pneumonitis

Mohammed

Mangeshkar²,

Rathmann

2021

Case Rep Oncol

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“…At this point, Osimertinib was discontinued and prednisolone therapy was initiated which led to improvement in respiratory function and resolution of lung opacities [17]. There has been some success in rechallenging patients with Osimertinib after developing DRP and using steroids to treat any pneumonitis are-ups [23].…”

Section: Discussionmentioning

confidence: 99%

Osimertinib-related Pulmonary Fibrosis, A case report and review of literature

Rasool,

Ferman,

Ozeir

et al. 2024

Preprint

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Lung cancers are the leading cause of mortality worldwide. Pulmonary malignancies are grossly divided into small-cell lung carcinoma and non-small-cell lung carcinoma. Non-small cell lung carcinoma contributes to the majority of tumor burden. The treatment regimen and subsequent prognosis for lung cancer depend on the type of cancer, the grade, and the stage. With the advancement in modern immunology and genetics, targeted treatment therapies targeted against specific genetic mutations and immune markers resulted in improved survival. Though these treatment modalities are considered to have minimal to no effect on co-existing normal tissues, there have been reports of side effects among patients on these advanced treatments. Here we present a case of 72 years old female with advanced metastatic non-small cell lung carcinoma who presented with significant deterioration of respiratory status. Initially, due to elevated inflammatory markers and fever, was treated with antibiotics. However, with worsening respiratory status despite being on appropriate antibiotics, she was started on steroids for the imaging findings suggestive of pulmonary fibrosis. Initiation of steroids resulted in rapid recovery, with the improvement of imaging findings and oxygen requirements. The patient was eventually discharged home without oxygen to follow up with hematology regarding further treatment. Osimertinib has been shown to improve progression-free survival compared to the earlier generations of EGFR TKIs, however, there are adverse effects to Osimertinib, with the most common being rash, diarrhea, and dry skin. More severe and potentially fatal, side effects like QT interval prolongation, interstitial lung disease, and drug-related pneumonitis are documented potential adverse effects as well. In all the reported cases, the removal of medication results in the improvement of pulmonary fibrosis. However, a few cases have reported successful reintroduction of Osimertinib once the fibrosis improves with no recurrence. There is a need to run blinded trials to find the association of Osimertinib with co-existent factors that can contribute to pulmonary fibrosis.

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“…Rechallenge after osimertinib-induced pneumonitis was reported in eight patients during the past 3 years. [22][23][24][25][26][27][28] The mechanism of osimertinib-induced pneumonitis is not fully understood, but in association with other drug-induced interstitial lung diseases, the pathogenesis is multifactorial, including a significant part of immunoreaction such as release of cytocines. 29 This indicates that steroids could potentially protect from recurrent pneumonitis in case of rechallenge.…”

Section: Discussionmentioning

confidence: 99%

Osimertinib rechallenge under steroid protection following osimertinib-induced pneumonitis: three case studies

et al. 2021

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Osimertinib is a third-generation tyrosine kinase inhibitor that became the preferred first-line treatment option for metastatic non-small cell lung cancer with sensitizing epidermal growth factor receptor mutations. Drug-induced pneumonitis is known to occur with osimertinib. In case of severe pneumonitis, discontinuation of treatment and therapy with corticosteroids is recommended, and a treatment switch is usually performed. We herein report the treatment course in three patients who were rechallenged with osimertinib under steroid protection following an osimertinib-induced pneumonitis. All our patients were initially re-exposed to a lower dose of osimertinib. Two patients were successfully rechallenged under prednisolone protection. The third patient, who was initially retreated with osimertinib without steroid protection, suffered from a recurrent pneumonitis, and was later rechallenged successfully under steroid protection. Our case series indicates that rechallenge with osimertinib following recovery from osimertinib-induced pneumonitis allows a successful rechallenge in individual cases when alternative treatment options are lacking. Concomitant steroids appear to protect against flares of pneumonitis during rechallenge.

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Successful osimertinib retreatment after extremely early onset severe pneumonitis in first‐line treatment of lung adenocarcinoma

Cited by 4 publications

References 12 publications

Successful Rechallenge with Osimertinib after Very Acute Onset of Drug-Induced Pneumonitis

Successful Rechallenge with Osimertinib after Very Acute Onset of Drug-Induced Pneumonitis

Osimertinib-related Pulmonary Fibrosis, A case report and review of literature

Osimertinib rechallenge under steroid protection following osimertinib-induced pneumonitis: three case studies

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