Successful Osimertinib Rechallenge with Steroid Therapy after Osimertinib-induced Interstitial Lung Disease

Kiriu, Tatsunori; Tamura, Daisuke; Tachihara, Motoko; Sekiya, Reina; Hazama, Daisuke; Katsurada, Masahiro; Nakata, Kyosuke; Nagano, Tatsuya; Yamamoto, Masatsugu; Kamiryo, Hiroshi; Kobayashi, Kazuyuki; Nishimura, Yoshihiro

doi:10.2169/internalmedicine.8947-17

Cited by 26 publications

(19 citation statements)

References 18 publications

(16 reference statements)

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“…However, there are no clear clinical guidelines in cases of symptomatic osimertinib‐induced pneumonitis. Several case reports have previously described successful retreatment with osimertinib along with systemic steroids, 6–8, 10 and there have been only three reports of osimertinib retreatment in cases of severe pneumonitis 9, 11 . We discontinued osimertinib and prescribed steroids, as in other cases.…”

Section: Discussionmentioning

confidence: 97%

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

Ahn

2020

Thoracic Cancer

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Drug‐induced pneumonitis is rare, and can result in death. Here, we present a report of a patient with adenocarcinoma harboring EGFR exon 19 deletion mutation treated with osimertinib as first‐line treatment. After six days of treatment, extremely early onset severe pneumonitis was diagnosed. Discontinuation of osimertinib as well as administration of corticosteroid, and retreatment with osimertinib were successful. This case report highlights that extremely early onset severe pneumonitis can occur after osimertinib administration, and retreatment of osimertinib may be a useful treatment option after resolution of pneumonitis.

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Section: Discussionmentioning

confidence: 97%

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

Ahn

2020

Thoracic Cancer

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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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“…In clinical practice, it is challenging to manage patients who develop severe osimertinib-induced ILD. Some reports have revealed the successful treatment of osimertinib rechallenge with concomitant corticosteroids in patients developing osimertinib-induced ILD [ [10] , [11] , [12] , [13] , [14] , [15] ]. On the other hand, there are limited reports on osimertinib rechallenge without concomitant corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment with afatinib following the failure of osimertinib rechallenge with osimertinib-induced interstitial lung disease: A case report

Sato

Sekine

Hagiwara

et al. 2021

Respiratory Medicine Case Reports

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Herein, we report the case of an 84-year-old woman with epidermal growth factor receptor ( EGFR ) mutation exon 19 deletion postoperative recurrent lung adenocarcinoma. Osimertinib was administered as a first-line treatment; however, she was urgently admitted to our hospital due to dyspnea on the 46th day. Chest computed tomography revealed bilateral diffuse ground-glass opacities (GGOs) suggestive of grade 3 osimertinib-induced interstitial lung disease (ILD). After discontinuation of osimertinib in combination with short-term corticosteroid therapy, widespread GGOs were promptly resolved. As the disease gradually deteriorated after discontinuation of osimertinib, we administered osimertinib (80 mg every other day) followed by careful observation. However, bilateral GGOs re-appeared on the 15th day, and the diagnosis of osimertinib-induced ILD was established. After the improvement in ILD following corticosteroid therapy, afatinib was administered as salvage therapy, resulting in desirable control of lung cancer without any relapse of ILD. Our results indicate that afatinib would be a promising alternative treatment option even in patients who develop osimertinib-induced ILD and experience failure of osimertinib rechallenge.

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Successful Osimertinib Rechallenge with Steroid Therapy after Osimertinib-induced Interstitial Lung Disease

Cited by 26 publications

References 18 publications

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

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

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

Successful treatment with afatinib following the failure of osimertinib rechallenge with osimertinib-induced interstitial lung disease: A case report

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