Exacerbation of radiation fibrosis with erlotinib: another pattern of radiation recall phenomenon

Abstract

A 79-year-old woman with advanced lung cancer presented with worsened radiation fibrosis after administration of erlotinib. After radiation therapy 7 months previously, she had radiation fibrosis that had been stable for months. On the 19th day after administration of erlotinib, low-grade fever and mild dyspnea developed accompanied by new pulmonary opacity in the area of the radiation fibrosis, which improved without therapy. We surmise that this is a manifestation of the radiation recall phenomenon, and discontinuation of the drug should be considered with discretion.

Targeted therapy-induced radiation recall

“…Previous case reports described RR, in the form of dermatitis or respiratory inflammation, after the administration of VEGFR/PDGFR and EGFR inhibitors (Table 4). 14,15,[20][21][22][23][24][25][26] We show here that other TT targeting diverse molecular pathways (mTOR, HDAC, IGF1R, CDK, BRAF, integrin), the cell-cycle and vasculature are also implicated in the occurrence of RR.…”

“…14,15,[20][21][22][23][24][25][26] TT consisted of VEGFR/ PDGFR (platelet-derived growth factor receptors) (n = 4) and EGFR (n = 5) inhibitors.…”

Recurrent radiation necrosis in the brain following stereotactic radiosurgery

“…Specifically, EGFR-mutant NSCLC has shown increased radiosensitivity relative to wild-type EGFR NSCLC, 8 and thus the tumor cells may have been radiosensitized through receipt of erlotinib. Additionally, erlotinib has been associated with various forms of radiation recall phenomena in nondermatologic settings, 9,10 and in this case erlotinib may have exacerbated the surrounding normal brain tissue's inflammatory response causing radiation necrosis as a form of radiation recall.…”

Radiation recall pneumonitis induced by ifosfamide for malignant soft tissue tumor arising from the chest wall: A case report

“…Some antitumor drugs are associated with a recall effect of pneumonitis after radiotherapy, especially doxorubicin (11,14), taxanes (14)(15)(16), gemcitabine (16), and molecular-target drugs such as vemurafenib (4) and erlotinib (10). The etiology and mechanism of radiation recall pneumonitis is unknown.…”