Successful Osimertinib Rechallenge After Osimertinib-induced Interstitial Lung Disease in a Patient with Postoperative Recurrence of Lung Cancer

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  • Matsuo Tsubasa
    Department of Thoracic Surgery, Akita University Graduate School of Medicine
  • Imai Kazuhiro
    Department of Thoracic Surgery, Akita University Graduate School of Medicine
  • Takashima Shinogu
    Department of Thoracic Surgery, Akita University Graduate School of Medicine
  • Atari Maiko
    Department of Thoracic Surgery, Akita University Graduate School of Medicine
  • Watanabe Shin-nosuke
    Department of Thoracic Surgery, Akita University Graduate School of Medicine
  • Minamiya Yoshihiro
    Department of Thoracic Surgery, Akita University Graduate School of Medicine

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Other Title
  • 薬剤性間質性肺炎発症後にステロイド内服下でのオシメルチニブ再投与が可能であった肺癌術後再発の1例

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<p>Introduction. Osimertinib, a third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), has shown significant efficacy and prolongation of the overall survival in patients with EGFR mutation-positive non-small cell lung cancer. However, drug-induced lung injury is recognized as one of the most severe adverse events. Case. A 58-year-old woman was diagnosed with pulmonary adenocarcinoma harboring an EGFR exon 19 deletion. After receiving her informed consent, left upper lobectomy and systemic lymph node dissection were performed. Three years after the surgery, the patient received gefitinib for multiple pulmonary metastases, and she experienced a partial response (PR); however, the disease progressed further. A computed tomography (CT)-guided percutaneous needle biopsy for pulmonary metastasis revealed an EGFR T790M mutation. The patient received osimertinib. A light cough without sputum appeared a year after osimertinib initiation, and CT showed a ground-glass shadow localized in the right middle lobe. Based on these findings, we diagnosed the patient with drug-induced lung injury. The patient discontinued osimertinib and started treatment with prednisolone immediately, but her pulmonary metastasis was re-enhanced. Although the patient switched to platinum-doublet chemotherapy, she was unable to maintain a PR. Eventually, we attempted rechallenge with osimertinib with 5 mg prednisolone daily. The patient is now receiving osimertinib treatment without disease progression or recurrence of drug-induced lung injury. Conclusion. This is a successful osimertinib rechallenge in a case with a history of steroid therapy osimertinib-induced lung injury.</p>

Journal

  • Haigan

    Haigan 59 (7), 1184-1189, 2019-12-20

    The Japan Lung Cancer Society

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