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

Abstract

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.

Successful administration of low-dose almonertinib in a patient with lung adenocarcinoma after osimertinib-induced interstitial lung disease: a case report and literature review

“…Targeted therapy has become an important treatment method for NSCLC, and EGFR-TKIs have provided a good therapeutic effect for NSCLC patients with EGFR mutation [ 9 ]. However, after taking EGFR-TKI, patients may need to stop or change their medicine due to drug resistance [ 13 , 14 ], ILD [ 5 , 15 ], and so on, just like the patient we reported. The most common mechanism of acquired resistance is EGFR T790M mutation, which affects the use of first- and second-generation EGFR-TKIs [ 13 ], while third-generation EGFR-TKIs, such as osimertinib, have good efficacy in T790M positive patients [ 16 , 17 ].…”

“…Therefore, timely intervention is very important. The majority of reported cases, including our case, successfully controlled OsiILD by discontinuing or reducing osimertinib and treating it with corticosteroids [ 5 , 15 , 27 , 28 , 30 , 32 – 35 , 37 , 38 ]. It has also been reported that OsiILD can be successfully controlled by nintedanib [ 36 ], so the use of nintedanib to control OsiILD can be considered in patients who are not suitable for corticosteroid therapy.…”

“…In several cases about OsiILD reported so far, most of the patients had risk factors, such as advanced age, contralateral lung metastasis, use of nivolumab and so on [3,5,15,[27][28][29][30][31][32][33][34][35][36][37][38]. The patient we reported was an elderly woman with contralateral lung metastasis, PS was grade 2, and she developed grade 3 ILD with acute lung injury after 3 months of treatment with osimertinib.…”

“…After the remission of OsiILD with acute lung injury, it is necessary to choose appropriate drugs to control tumor progression and prolong the survival time of patients. Most of the reported cases of rechallenge of EGFR-TKI after OsiILD were treated with osimertinib [ 27 , 30 , 33 – 35 , 38 ], and a few patients without T790M mutation used first- or second-generation EGFR-TKI, such as gefitinib [ 36 ] and afatinib [ 15 , 37 ], all of which successfully controlled the tumor progression. Moreover, in the cases of using osimertinib, one part used the regular dose (80 mg per day) [ 26 , 34 , 35 ], and the other part reduced the dose (40 mg per day or 80 mg every other day) [ 27 , 30 , 33 , 38 ], which all achieved good therapeutic effect.…”

“…According to current research, OsiILD may be primarily associated with a history or complication of ILD and previous treatment with programmed cell death protein-1 (PD-1) inhibitors such as nivolumab [22,26]. In several cases about OsiILD reported so far, most of the patients had risk factors, such as advanced age, contralateral lung metastasis, use of nivolumab and so on [3,5,15,27–38]. The patient we reported was an elderly woman with contralateral lung metastasis, PS was grade 2, and she developed grade 3 ILD with acute lung injury after 3 months of treatment with osimertinib.…”