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Michelon I, Vilbert M, do Rego Castro CE, Stecca C, Dacoregio MI, Rizzo M, Cláudio Cordeiro de Lima V, Cavalcante L. EGFR-Tyrosine Kinase Inhibitor Retreatment in Non-Small-Cell Lung Cancer Patients Previously Exposed to EGFR-TKI: A Systematic Review and Meta-Analysis. J Pers Med 2024; 14:752. [PMID: 39064005 PMCID: PMC11277985 DOI: 10.3390/jpm14070752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
We performed a systematic review and meta-analysis to assess the efficacy of EGFR-tyrosine kinase inhibitors (TKI) retreatment in advanced/metastatic non-small-cell lung cancer (NSCLC) patients. We systematically searched PubMed, Embase, Cochrane databases, ASCO, and ESMO websites for studies evaluating EGFR-TKI retreatment in advanced/metastatic NSCLC patients. All analyses were performed using R software (v.4.2.2). We included 19 studies (9 CTs and 10 retrospective cohorts) with a total of 886 patients. In a pooled analysis of all patients during retreatment with TKI, median OS was 11.7 months (95% confidence interval [CI] 10.2-13.4 months) and PFS was 3.2 months (95% CI 2.5-3.9 months). ORR was 15% (95% CI 10-21%) and DCR was 61% (95% CI 53-67%). The subanalysis by generation of TKI in the rechallenge period revealed a slightly better ORR for patients on 3rd generation TKI (p = 0.05). Some limitations include the high heterogeneity of some of the analyses and inability to perform certain subanalyses. Our results unequivocally support the benefit of EGFR-TKI rechallenge in EGFR-mutated NSCLC patients progressing on TKI treatment after a TKI-free interval. These findings may be especially valuable in areas where access to novel therapeutic drugs and clinical trials is limited.
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Affiliation(s)
- Isabella Michelon
- Department of Medicine, Catholic University of Pelotas, Pelotas 96015-560, Brazil
| | - Maysa Vilbert
- Massachusetts General Hospital Cancer Center, Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA;
| | | | - Carlos Stecca
- Department of Medicine, Parana Oncology Center, Curitiba 80030-200, Brazil;
| | - Maria Inez Dacoregio
- Department of Medicine, University of Centro Oeste, Guarapuava 85040-167, Brazil;
| | - Manglio Rizzo
- Cancer Immunobiology Laboratory, Instituto de Investigaciones en Medicina Traslacional, Universidad Austral-Consejo Nacional de Investigaciones Cientificas y Tecnologicas (CONICET), Buenos Aires 1428, Argentina;
- Clinical Oncology Unit, Hospital Universitario Austral, Av. Presidente Perón 1500, (B1629ODT) Derqui-Pilar, Buenos Aires 1428, Argentina
| | | | - Ludimila Cavalcante
- Department of Hematology and Medical Oncology, University of Virginia Comprehensive Cancer Center, Charlottesville, VA 22903, USA;
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Gu X, Zhong Y, Huang H. Case report: EGFR-TKI rechallenge after osimertinib-induced interstitial lung disease: a case report and literature review. Front Pharmacol 2024; 15:1410684. [PMID: 38895622 PMCID: PMC11183107 DOI: 10.3389/fphar.2024.1410684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
Background Osimertinib, a third-generation tyrosine kinase inhibitor (TKI), has demonstrated significant efficacy in treating non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) mutations. However, EGFR-TKI-induced interstitial lung disease (ILD), a well-known adverse effect, can seriously affect the treatment outcome. There is currently no international consensus on the efficacy and safety of re-administration of EGFR-TKI after EGFR-TKI-induced ILD. Case summary We report a case of a 62-year-old male with stage IV lung adenocarcinoma and EGFR L858R mutation who was treated with osimertinib at a dose of 80 mg/day as first-line therapy. On the sixth day of treatment, the patient developed grade 4 ILD, chest tightness, shortness of breath, and paroxysmal dry cough. Arterial blood gas analysis indicated the presence of type I respiratory failure, while the chest CT scan revealed newly developed ground-glass opacities in both lungs and a considerable amount of pleural effusion on the left side. Subsequently, the patient was administered methylprednisolone for anti-inflammatory therapy, in conjunction with oxygen therapy, anti-infection treatment, and closed thoracic drainage, which resulted in a favourable recovery and discharge after 18 days. During this period, the patient adhered to third-generation EGFR-TKI oral targeted therapy. Nevertheless, within a week of discharge, the patient was readmitted due to the recurrence of chest tightness and shortness of breath. A chest CT scan indicated a recurrent ILD. Despite the administration of high-dose methylprednisolone for 9 days, the patient's condition continued to deteriorate, ultimately resulting in death. Conclusion It is of the utmost importance to conduct a meticulous evaluation of the severity of osimertinib-induced ILD in order to ascertain the potential risks and benefits of EGFR-TKI rechallenge. Particularly, for patients with grade 4 ILD, firm drug discontinuation should be considered.
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Affiliation(s)
- Xiaofei Gu
- Department of Respiratory and Critical Care Medicine, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yonghong Zhong
- Department of Respiratory and Critical Care Medicine, Linping Campus, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Huaqiong Huang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Nishioka N, Imai H, Endo M, Notsu A, Doshita K, Igawa S, Yokouchi H, Ninomiya T, Tokito T, Soda S, Fujiwara T, Asao T, Nakamichi S, Kawamura T, Inomata M, Nakashima K, Ito K, Goto Y, Umeda Y, Hirai S, Ushio R, Yokoo K, Takeda T, Fukui T, Ishihara M, Osaki T, Kubo S, Fujiwara T, Yamamoto C, Tsuda T, Tamura N, Hosokawa S, Chihara Y, Ikeda S, Furuya N, Nakahara Y, Miura S, Okamoto H. Real-World Data on Subsequent Therapy for First-Line Osimertinib-Induced Pneumonitis: Safety of EGFR-TKI Rechallenge (Osi-risk Study TORG-TG2101). Target Oncol 2024; 19:423-433. [PMID: 38613731 PMCID: PMC11111546 DOI: 10.1007/s11523-024-01048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Although osimertinib is a promising therapeutic agent for advanced epidermal growth factor receptor (EGFR) mutation-positive lung cancer, the incidence of pneumonitis is particularly high among Japanese patients receiving the drug. Furthermore, the safety and efficacy of subsequent anticancer treatments, including EGFR-tyrosine kinase inhibitor (TKI) rechallenge, which are to be administered after pneumonitis recovery, remain unclear. OBJECTIVE This study investigated the safety of EGFR-TKI rechallenge in patients who experienced first-line osimertinib-induced pneumonitis, with a primary focus on recurrent pneumonitis. PATIENTS AND METHODS We retrospectively reviewed the data of patients with EGFR mutation-positive lung cancer who developed initial pneumonitis following first-line osimertinib treatment across 34 institutions in Japan between August 2018 and September 2020. RESULTS Among the 124 patients included, 68 (54.8%) patients underwent EGFR-TKI rechallenge. The recurrence rate of pneumonitis following EGFR-TKI rechallenge was 27% (95% confidence interval [CI] 17-39) at 12 months. The cumulative incidence of recurrent pneumonitis was significantly higher in the osimertinib group than in the first- and second-generation EGFR-TKI (conventional EGFR-TKI) groups (hazard ratio [HR] 3.1; 95% CI 1.3-7.5; p = 0.013). Multivariate analysis revealed a significant association between EGFR-TKI type (osimertinib or conventional EGFR-TKI) and pneumonitis recurrence, regardless of severity or status of initial pneumonitis (HR 3.29; 95% CI 1.12-9.68; p = 0.03). CONCLUSIONS Osimertinib rechallenge after initial pneumonitis was associated with significantly higher recurrence rates than conventional EGFR-TKI rechallenge.
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Affiliation(s)
- Naoya Nishioka
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Respiratory Medicine, Fukuchiyama City Hospital, Kyoto, Japan
| | - Hisao Imai
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Yamane 1397-1, Hidaka City, Saitama, Japan.
| | - Masahiro Endo
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akifumi Notsu
- Division of Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kosei Doshita
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Satoshi Igawa
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Hiroshi Yokouchi
- Department of Respiratory Medicine, NHO Hokkaido Cancer Center, Hokkaido, Japan
| | - Takashi Ninomiya
- Department of Thoracic Oncology and Medicine, NHO Shikoku Cancer Center, Matsuyama, Ehime, Japan
| | - Takaaki Tokito
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Sayo Soda
- Department of Pulmonary and Clinical Immunology, Dokkyo Medical University School of Medicine, Tohigi, Japan
| | - Takasato Fujiwara
- Department of Respiratory Internal Medicine, Yokosuka Kyosai Hospital, Kanagawa, Japan
| | - Tetsuhiko Asao
- Department of Respiratory Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Shinji Nakamichi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takahisa Kawamura
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Minehiko Inomata
- 1st Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
| | - Kazuhisa Nakashima
- Division of Medical Oncology and Respiratory Medicine, Department of Internal Medicine, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Kentaro Ito
- Respiratory Center, Matsusaka Municipal Hospital, Mie, Japan
| | - Yasuhiro Goto
- Department of Respiratory Medicine, Fujita Health University School of Medicine, Aichi, Japan
| | - Yukihiro Umeda
- Third Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Soichi Hirai
- Department of Pulmonary Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryota Ushio
- Department of Thoracic Oncology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Keiki Yokoo
- Department of Respiratory Medicine, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Takayuki Takeda
- Department of Respiratory Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Tomoya Fukui
- Department of Respiratory Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Masashi Ishihara
- Division of Medical Oncology, Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Takashi Osaki
- Department of Respiratory Medicine, Shibukawa Medical Center, Gunma, Japan
| | - Sousuke Kubo
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Takumi Fujiwara
- Department of Genomic Medicine, Mie University Hospital, Mie, Japan
| | - Chie Yamamoto
- Department of Respiratory Medicine, Fukuchiyama City Hospital, Kyoto, Japan
| | - Takeshi Tsuda
- Division of Respiratory Medicine, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Nobumasa Tamura
- Division of Respiratory Diseases, Department of Internal Medicine, Atsugi City Hospital, Kanagawa, Japan
| | - Shinobu Hosokawa
- Department of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama, Japan
| | - Yusuke Chihara
- Department of Respiratory Medicine, Uji-Tokushukai Medical Center, Kyoto, Japan
| | - Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Kanagawa, Japan
| | - Naoki Furuya
- Division of Respiratory Medicine, Department of Internal Medicine, St Marianna University School of Medicine, Kanagawa, Japan
| | - Yoshiro Nakahara
- Department of Respiratory Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Satoru Miura
- Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hiroaki Okamoto
- Department of Respiratory Medicine, Yokohama Municipal Citizen's Hospital, Yokohama, Kanagawa, Japan
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Ito T, Tsuchiya K, Mori R, Akashi T, Oyama Y, Ikeda M. Successful osimertinib rechallenge without concomitant corticosteroids after osimertinib-induced pneumonitis. Respir Med Case Rep 2024; 49:102029. [PMID: 38712314 PMCID: PMC11070756 DOI: 10.1016/j.rmcr.2024.102029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 04/26/2024] [Indexed: 05/08/2024] Open
Abstract
A 60-year-old woman was diagnosed with cT4N3M1c stage IVB lung adenocarcinoma with epidermal growth factor receptor mutation of exon19 deletion. After one month of treatment with osimertinib, a cough and diffuse ground glass opacities were observed in the bilateral lung field. Based on the clinical course and the exclusion of other etiologies, osimertinib-induced pneumonitis was diagnosed. The shadows resolved after osimertinib was discontinued. However, brain metastasis and leptomeningeal metastasis developed 20 months later; therefore, osimertinib was re-administered without concomitant corticosteroids. The pulmonary lesion and leptomeningeal metastasis were successfully treated without recurrence of drug-induced pneumonitis for eight months.
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Affiliation(s)
- Taisuke Ito
- Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital, Shizuoka City, Shizuoka, Japan
| | - Kazuo Tsuchiya
- Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital, Shizuoka City, Shizuoka, Japan
| | - Rie Mori
- Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital, Shizuoka City, Shizuoka, Japan
| | - Takuro Akashi
- Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital, Shizuoka City, Shizuoka, Japan
| | - Yoshiyuki Oyama
- Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital, Shizuoka City, Shizuoka, Japan
| | - Masaki Ikeda
- Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital, Shizuoka City, Shizuoka, Japan
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5
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Li MS, Lee KW, Mok KK, Loong HH, Lam K, Mok FS, Chan LL, Lau Y, Chan K, Ng JT, Wong WK, Lam BH, Chen AC, Lee MM, Chen OH, Mok TS. Brief Report: Risk of Recurrent Interstitial Lung Disease From Osimertinib Versus Erlotinib Rechallenge After Symptomatic Osimertinib-Induced Interstitial Lung Disease. JTO Clin Res Rep 2024; 5:100648. [PMID: 38590729 PMCID: PMC10999481 DOI: 10.1016/j.jtocrr.2024.100648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 04/10/2024] Open
Abstract
Introduction Interstitial lung disease (ILD) is the most frequent cause of drug-related mortality from EGFR tyrosine kinase inhibitors (TKIs). Yet, for patients with symptomatic osimertinib-induced ILD, the risk of recurrent ILD associated with EGFR TKI rechallenge, either with osimertinib or another TKI, such as erlotinib, is unclear. Methods Retrospective study of 913 patients who received osimertinib treatment for EGFR mutation-positive NSCLC. Clinical characteristics, ILD treatment history, and subsequent anticancer therapy of patients with symptomatic osimertinib-induced ILD were collated. The primary end point was to compare the incidence of recurrent ILD with osimertinib versus erlotinib rechallenge. Results Of 913 patients, 35 (3.8%) had symptomatic osimertinib-induced ILD, of which 12 (34%), 15 (43%), and eight (23%) had grade 2, 3 to 4, and 5 ILD, respectively. On ILD recovery, 17 patients had EGFR TKI rechallenge with eight received osimertinib and nine received erlotinib. The risk of recurrent ILD was higher with osimertinib rechallenge than erlotinib (p = 0.0498). Of eight, five (63%) developed recurrent ILD on osimertinib rechallenge, including three patients with fatal outcomes. In contrast, only one of nine patients (11%) treated with erlotinib had recurrent ILD. Median time to second ILD occurrence was 4.7 (range 0.7-12) weeks. Median time-to-treatment failure of patients with erlotinib rechallenge was 13.2 months (95% confidence interval: 8.6-15.0). Conclusions The risk of recurrent ILD was considerably higher with osimertinib rechallenge than erlotinib. Osimertinib rechallenge should be avoided, whereas erlotinib may be considered in patients with symptomatic osimertinib-induced ILD.
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Affiliation(s)
- Molly S.C. Li
- Department of Clinical Oncology, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong
- State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong
| | - Kirsty W.C. Lee
- Department of Clinical Oncology, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong
| | - Kevin K.S. Mok
- Department of Clinical Oncology, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong
| | - Herbert H.F. Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong
| | - K.C. Lam
- Department of Clinical Oncology, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong
| | - Florence S.T. Mok
- Department of Clinical Oncology, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong
| | - Landon L. Chan
- Department of Clinical Oncology, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong
| | - Y.M. Lau
- Department of Oncology/Haematology, St Vincent’s Hospital, Sydney, Australia
| | - K.P. Chan
- Department of Medicine, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong
| | - Joyce T.Y. Ng
- Department of Clinical Oncology, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong
| | - Wesley K.Y. Wong
- Department of Clinical Oncology, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong
| | - Benjamin H.W. Lam
- Department of Clinical Oncology, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong
| | - Allen C.C. Chen
- Department of Clinical Oncology, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong
| | - Matthew M.P. Lee
- Department of Clinical Oncology, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong
| | - Olivia H. Chen
- Department of Clinical Oncology, Prince of Wales Hospital, Sha Tin, New Territories, Hong Kong
| | - Tony S.K. Mok
- Department of Clinical Oncology, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong
- State Key Laboratory of Translational Oncology, The Chinese University of Hong Kong, Sha Tin, New Territories, Hong Kong
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Araki T, Kanda S, Obara M, Agatsuma T, Kakizaki Y, Hama M, Yamamoto H, Takada M, Yamamoto M, Matsuo A, Kondo D, Komatsu M, Sonehara K, Tateishi K, Hanaoka M, Koizumi T. EGFR-TKI rechallenge in patients with EGFR-mutated non-small-cell lung cancer who progressed after first-line osimertinib treatment: A multicenter retrospective observational study. Respir Investig 2024; 62:262-268. [PMID: 38245931 DOI: 10.1016/j.resinv.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/19/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Rechallenge therapy with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) is known to confer some clinical benefit for patients with metastatic EGFR-mutated non-small cell lung cancer (NSCLC). However, little is known about the efficacy of EGFR-TKI rechallenge after resistance to first-line (1L) osimertinib. This study aimed to assess the efficacy and safety of EGFR-TKI rechallenge therapy after resistance to 1L osimertinib in a Japanese clinical setting. METHODS Between April 2018 and August 2022, 26 patients who progressed after treatment with 1L osimertinib and received EGFR-TKI rechallenge were included in this multicenter retrospective analysis. Patients in whom 1L osimertinib was discontinued owing to toxicity and had subsequent disease progression were also included in the analysis. RESULTS Overall, the objective response rate for rechallenge therapy was 23.1%. The disease control rate was 53.9%, and the median progression-free survival (PFS) was 3.4 months. Patients who discontinued 1L osimertinib for toxicity had a higher response rate (42.9% vs. 15.8%) and longer PFS than those who discontinued it due to disease progression (median: 11.4 vs. 2.7 months, P = 0.001). Three patients (11.5%) developed rechallenge therapy-associated pneumonitis, two of which were grade ≥3. CONCLUSIONS Rechallenge with EGFR-TKI after 1L osimertinib resistance showed limited clinical efficacy. However, it could be considered as a subsequent salvage therapeutic option for patients in whom 1L osimertinib was discontinued owing to toxicity.
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Affiliation(s)
- Taisuke Araki
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Shintaro Kanda
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Miho Obara
- Department of Pharmacy, Shinshu University Hospital, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Toshihiko Agatsuma
- Department of Respiratory Medicine, Shinshu Ueda Medical Center, 1-27-21, Midorigaoka, Ueda, Nagano, 386-8610, Japan
| | - Yumiko Kakizaki
- Lung Cancer and Respiratory Disease Center, Yamanashi Prefectural Central Hospital, 1-1-1, Fujimi, Kofu, Yamanashi, 400-8506, Japan
| | - Mineyuki Hama
- Department of Respiratory Medicine, Japanese Red Cross Society Suwa Hospital, 5-11-50, Kogandori Suwa, Nagano, 390-0027, Japan
| | - Hiroshi Yamamoto
- Department of Respiratory Medicine, Iida Municipal Hospital, 438, Yawatamachi, Iida, 395-0814, Japan
| | - Munetake Takada
- Department of Respiratory Medicine, Jiseikai Aizawa Hospital, 2-5-1, Honjo, Matsumoto, Nagano, 390-8510, Japan
| | - Manabu Yamamoto
- Department of Respiratory Medicine, Japanese Red Cross Society Nagano Hospital, 5-22-1, Wakasato, Nagano, Nagano, 380-8582, Japan
| | - Akemi Matsuo
- Department of Respiratory Medicine, Minaminagano Medical Center, 666-1, Shinonoiai, Shinonoi General Hospital, 388-8004, Nagano, Japan
| | - Daichi Kondo
- Department of Respiratory Medicine, Hokushin General Hospital, 1-5-63, Nishi, Nakano, Nagano, 383-8505, Japan
| | - Masamichi Komatsu
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Kei Sonehara
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Kazunari Tateishi
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Masayuki Hanaoka
- First Department of Internal Medicine, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tomonobu Koizumi
- Department of Hematology and Medical Oncology, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, Nagano, 390-8621, Japan
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7
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Kanaji N, Ichihara E, Tanaka T, Ninomiya T, Kozuki T, Ishikawa N, Nishii K, Shoda H, Yamaguchi K, Kawakado K, Toyoda Y, Inoue M, Miyatake N, Watanabe N, Inoue T, Mizoguchi H, Komori Y, Kojima K, Kadowaki N. Efficacy and Safety of Re-administration of Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor (EGFR-TKI) After EGFR-TKI-Induced Interstitial Lung Disease (CS-Lung-005). Lung 2024; 202:63-72. [PMID: 38265672 PMCID: PMC10896789 DOI: 10.1007/s00408-023-00669-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/23/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE This study investigated the safety and efficacy of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) re-administration after recovery from EGFR-TKI-induced interstitial lung disease (ILD). METHODS This multicenter retrospective study collected data from consecutive advanced NSCLC patients who underwent EGFR-TKI re-administration after recovery from EGFR-TKI-induced ILD. RESULTS Fifty-eight patients were registered. The grades of initial TKI-induced ILD were grade 1 to 4. TKIs used for re-administration were erlotinib for 15 patients, osimertinib for 15, gefitinib for 14, afatinib for 13 patients, and dacomitinib for 1 patient. ILD recurred in 13 patients (22.4%), comprising 3 patients with grade 1, 6 patients with grade 2, and 4 patients with grade 3. No significant associations were found between ILD recurrence and age, smoking history, performance status, time from initial ILD to TKI re-administration, or concomitant corticosteroid use. However, the incidence of ILD recurrence was high in cases of repeated use of gefitinib or erlotinib or first time use of osimertinib at TKI re-administration. The ILD recurrence rate was lowest in patients treated with first time use of gefitinib (8%) or erlotinib (8%), followed by patients treated with repeated use of osimertinib (9%). The response rate, median progression-free survival by TKI re-administration, and median overall survival were 55%, 9.6 and 84.8 months, respectively. CONCLUSION This study showed that EGFR-TKI re-administration is a feasible and effective treatment for patients who recovered from EGFR-TKI-induced ILD. Our results indicate that re-administration of EGFR-TKI is an important option for long-term prognosis after recovery from EGFR-TKI-induced ILD.
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Affiliation(s)
- Nobuhiro Kanaji
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
| | - Eiki Ichihara
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Takaaki Tanaka
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Takashi Ninomiya
- Department of Thoracic Oncology and Medicine, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Toshiyuki Kozuki
- Department of Thoracic Oncology and Medicine, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Nobuhisa Ishikawa
- Department of Respiratory Medicine, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Kazuya Nishii
- Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, Yamaguchi, Japan
| | - Hiroyasu Shoda
- Department of Respiratory Medicine, Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kakuhiro Yamaguchi
- Department of Respiratory Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Keita Kawakado
- Department of Internal Medicine, Division of Medical Oncology and Respiratory Medicine, Shimane University Faculty of Medicine, Shimane, Japan
| | - Yuko Toyoda
- Department of Internal Medicine, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Masaaki Inoue
- Department of Chest Surgery, Shimonoseki City Hospital, Shimonoseki, Japan
| | - Nobuyuki Miyatake
- Department of Hygiene, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Naoki Watanabe
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Takuya Inoue
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Hitoshi Mizoguchi
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yuta Komori
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Kazuki Kojima
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Norimitsu Kadowaki
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
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Kashizaki F, Chen H, Miyasaka A, Tsuchiya N, Yamada C, Okazaki S, Kaneko M, Kano T, Kameda Y, Kikuchi A, Yumoto K, Osawa H, Koizumi H, Takahashi K, Kaneko T. Safety of Readministration of EGFR-TKI After Onset of Interstitial Lung Disease in Advanced EGFR-Mutated NSCLC: A Systematic Review and Meta-Analysis. Clin Lung Cancer 2024; 25:e52-e57.e2. [PMID: 37932180 DOI: 10.1016/j.cllc.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/30/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND In patients with epidermal growth factor receptor (EGFR) mutated non-small-cell lung cancer (NSCLC), EGFR-tyrosine kinase inhibitor (TKI) interruption due to EGFR-TKI-induced interstitial lung disease (ILD) is a factor for shorter overall survival (OS). Several retrospective cohort studies have reported an OS-prolonging effect of the readministration of EGFR-TKIs. This study aimed to determine the safety of readministration of EGFR-TKIs after the onset of EGFR-TKI-induced ILD. METHODS The PubMed, CINAHL, and Web of Science databases were systematically searched until May 30, 2023. The primary outcome was successful readministration of EGFR-TKIs after the onset of EGFR-TKI-induced ILD. RESULTS A total of 690 patients were included in this meta-analysis. The initial EGFR-TKI-induced ILD rate was 13.6% (95% confidence interval [CI]:6.4-20.9). Readministration rate of EGFR-TKI after onset of EGFR-TKI-induced ILD was 40.2% (95% CI: 26.7-53.7). The successful readministration rate of EGFR-TKIs after onset of EGFR-TKI-induced ILD was 81.9% (95% CI: 73.8-90.0). Successful rate of EGFR-TKI readministration in patients with Grade 2 or higher adverse events post initial EGFR-TKI therapy was 76.1% (95% CI: 55.6-96.6). CONCLUSIONS Although initial EGFR-TKI-induced ILD has a relatively high incidence, EGFR-TKI readministration after the onset of EGFR-TKI-induced ILD may be a viable treatment option.
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Affiliation(s)
- Fumihiro Kashizaki
- Department of Respiratory Medicine, Yokohama Minami Kyosai Hospital, Yokohama Japan.
| | - Hao Chen
- Department of Respiratory Medicine, Yokohama Minami Kyosai Hospital, Yokohama Japan
| | - Atsushi Miyasaka
- Department of Respiratory Medicine, Yokohama Minami Kyosai Hospital, Yokohama Japan
| | - Nanami Tsuchiya
- Department of Respiratory Medicine, Yokohama Minami Kyosai Hospital, Yokohama Japan
| | - Chihiro Yamada
- Department of Respiratory Medicine, Yokohama Minami Kyosai Hospital, Yokohama Japan
| | - Shunsuke Okazaki
- Department of Respiratory Medicine, Yokohama Minami Kyosai Hospital, Yokohama Japan
| | - Mai Kaneko
- Department of Respiratory Medicine, Yokohama Minami Kyosai Hospital, Yokohama Japan
| | - Taiki Kano
- Department of Respiratory Medicine, Yokohama Minami Kyosai Hospital, Yokohama Japan
| | - Yohei Kameda
- Department of General thoracic surgery, Yokohama Minami Kyosai Hospital, Yokohama Japan
| | - Akitomo Kikuchi
- Department of General thoracic surgery, Yokohama Minami Kyosai Hospital, Yokohama Japan
| | - Kentaro Yumoto
- Department of Respiratory Medicine, Yokohama Minami Kyosai Hospital, Yokohama Japan
| | - Hiroyuki Osawa
- Department of General thoracic surgery, Yokohama Minami Kyosai Hospital, Yokohama Japan
| | - Harumi Koizumi
- Department of Respiratory Medicine, Yokohama Minami Kyosai Hospital, Yokohama Japan
| | - Kenichi Takahashi
- Department of Respiratory Medicine, Yokohama Minami Kyosai Hospital, Yokohama Japan
| | - Takeshi Kaneko
- Department of Respiratory Medicine, Yokohama City University Hospital, Yokohama Japan
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Lopez M, Hagopian G, Doan L, Lee BJ, Rojek NW, Smith J, Ou SHI, Demirdag YY, Nagasaka M. Osimertinib tolerance in a patient with Stevens Johnson syndrome during osimertinib therapy after treatment with pembrolizumab. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:93. [PMID: 37898814 PMCID: PMC10612162 DOI: 10.1186/s13223-023-00849-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/07/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Osimertinib has emerged as an important tool in the treatment of non-small cell lung cancers (NSCLC) with certain activating mutations of epidermal growth factor receptor (EGFR). However, Osimertinib may cause adverse effects, including severe cutaneous adverse reactions (SCARs) such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The risk of certain adverse effects may be increased in the setting of recent use of immune checkpoint inhibitor (ICI) therapy, although it is unclear whether recent use of ICI therapy is a risk factor for Osimertinib-induced SJS specifically. CASE PRESENTATION We present a patient with EGFR L858R mutation-positive metastatic NSCLC who developed Osimertinib-induced SJS after recent administration of eight cycles of a pembrolizumab-containing chemotherapy regimen. Osimertinib, which was the best treatment targeting his lung cancer, was avoided due to history of SJS. Four years later, because of unresponsiveness or side effects of alternative treatments, he underwent Osimertinib challenge and tolerated it. CONCLUSION This case highlights the importance of multi-disciplinary care and supports the hypothesis that the risk of SJS to Osimertinib is significantly higher in the context of recent administration of ICI therapy and, patients may tolerate Osimertinib after certain time has elapsed after the last dose of ICI.
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Affiliation(s)
- Michael Lopez
- Division of Basic and Clinical Immunology, Department of Medicine, University of California, Irvine, USA
| | - Garo Hagopian
- Division of Hematology and Oncology, Department of Medicine, University of California, Irvine, USA
| | - Linda Doan
- Department of Dermatology, University of California, Irvine, USA
| | - Benjamin J Lee
- Department of Pharmacology, University of California, Irvine, USA
| | - Nathan W Rojek
- Department of Dermatology, University of California, Irvine, USA
| | - Janellen Smith
- Department of Dermatology, University of California, Irvine, USA
| | - Sai-Hong Ignatius Ou
- Division of Hematology and Oncology, Department of Medicine, University of California, Irvine, USA
| | - Yesim Yilmaz Demirdag
- Division of Basic and Clinical Immunology, Department of Medicine, University of California, Irvine, USA.
| | - Misako Nagasaka
- Division of Hematology and Oncology, Department of Medicine, University of California, Irvine, USA
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Imaji M, Fujimoto D, Sato Y, Sakata Y, Oya Y, Tamiya M, Suzuki H, Ikeda H, Kijima T, Matsumoto H, Kanazu M, Hino A, Inaba M, Tsukita Y, Arai D, Maruyama H, Hara S, Tsumura S, Kobe H, Sumikawa H, Sakata S, Yamamoto N. Safety and efficacy of osimertinib rechallenge or continuation after pneumonitis: A multicentre retrospective cohort study. Eur J Cancer 2023; 179:15-24. [PMID: 36470023 DOI: 10.1016/j.ejca.2022.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/24/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Although osimertinib is a standard first-line treatment for patients with advanced-stage non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations, the incidence rate of pneumonitis associated with osimertinib is high. However, there are few reports about the safety and efficacy of osimertinib rechallenge after the development of pneumonitis. METHODS We conducted a retrospective multicentre cohort study of consecutive patients who developed pneumonitis associated with osimertinib as a first-line and received osimertinib rechallenge. The primary outcome was the incidence rate of any grade pneumonitis after osimertinib rechallenge. The secondary outcome was treatment efficacy in patients after osimertinib rechallenge. RESULTS In total, 33 patients who received osimertinib rechallenge were included. Of them, 26 patients had grade 1, 6 patients had grade 2, and 1 patient had grade 3 initial pneumonitis. The median follow-up period after the osimertinib rechallenge was 16.9 months (interquartile range, 11.1-21.3 months). After the start of osimertinib rechallenge, five patients (15%) experienced mild relapsed pneumonitis. Three of the five patients had similar imaging patterns for initial and relapsed pneumonitis. No significant differences in characteristics were observed between patients with and without relapsed pneumonitis. The median progression-free survival after osimertinib rechallenge was not achieved (95% confidence interval: 10.3 months - not reached). CONCLUSION Osimertinib rechallenge was feasible and effective for patients who developed initial pneumonitis associated with first-line osimertinib therapy. Osimertinib might be considered a treatment option even after the development of mild initial pneumonitis.
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Affiliation(s)
- Mihoko Imaji
- Internal Medicine III, Wakayama Medical University, Wakayama 641-8509, Japan
| | - Daichi Fujimoto
- Internal Medicine III, Wakayama Medical University, Wakayama 641-8509, Japan.
| | - Yuki Sato
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Yoshihiko Sakata
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Yuko Oya
- Department of Thoracic Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Motohiro Tamiya
- Department of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Hidekazu Suzuki
- Department of Thoracic Oncology, Osaka Habikino Medical Center, Osaka, Japan
| | - Hideki Ikeda
- Department of Respiratory Medicine, Kimitsu Chuo Hospital, Chiba, Japan; Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Takashi Kijima
- Department of Respiratory Medicine and Hematology, Hyogo Medical University, Hyogo, Japan
| | - Hirotaka Matsumoto
- Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Masaki Kanazu
- Department of Thoracic Oncology, National Hospital Organization Osaka Toneyama Medical Center, Osaka, Japan
| | - Aoi Hino
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Megumi Inaba
- Division of Respiratory Medicine, Kumamoto Chuo Hospital, Kumamoto, Japan
| | - Yoko Tsukita
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Daisuke Arai
- Department of Internal Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Hirotaka Maruyama
- Department of Respiratory Medicine, Japan Organization of Occupational Health and Safety, Kumamoto Rosai Hospital, Kumamoto, Japan
| | - Satoshi Hara
- Department of Respiratory Medicine, Itami City Hospital, Hyogo, Japan
| | - Shinsuke Tsumura
- Department of Respiratory Medicine, Kumamoto Regional Medical Center, Kumamoto, Japan
| | - Hiroshi Kobe
- Department of Respiratory Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Hiromitsu Sumikawa
- Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Shinya Sakata
- Department of Respiratory Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Nobuyuki Yamamoto
- Internal Medicine III, Wakayama Medical University, Wakayama 641-8509, Japan
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11
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Mimura C, Kaneshiro K, Fujimoto S, Dokuni R, Iwamoto N, Matsumura K, Hatakeyama Y, Kono Y, Tachihara M. TAPO in first-line osimertinib therapy and continuation of osimertinib. Thorac Cancer 2022; 14:584-591. [PMID: 36578073 PMCID: PMC9968596 DOI: 10.1111/1759-7714.14782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Osimertinib is associated with a relatively high frequency of drug-induced interstitial lung disease (D-ILD), and transient asymptomatic pulmonary opacities (TAPO) have been reported to occur during osimertinib administration. The frequency of TAPO during first-line treatment and the pros and cons of osimertinib continuation is unknown. METHODS This was a multicenter, retrospective study. The purpose of this study was to research the frequency of TAPO and to evaluate osimertinib continuation in first-line therapy. We also evaluated progression-free survival (PFS) including subgroup analysis. RESULTS From August 2018 to December 2020, 133 patients were enrolled into the study. The median observation period was 23.2 months (0.3-48.3 months). Thirty patients (22.6%) experienced D-ILD events, including 16 patients (12.1%) with CTCAE grade 1, five patients (3.8%) with grade 2, and nine patients (6.7%) with grade 3 and above D-ILD. Among the patients with grade 1 D-ILD, 11 cases (8.3%) of TAPO were observed, and all patients succeeded in osimertinib continuation. The TAPO images were characterized by localized patchy opacities (73%). The median PFS was 22.6 months (95% confidence interval [CI]: 17.8-28.7 months). Patients with TAPO had a significantly longer PFS than patients with non-TAPO D-ILD in the multivariate analysis. CONCLUSIONS This study showed that grade 1 D-ILD might include TAPO and that patients with TAPO might have good PFS. We need to consider the possibility of osimertinib continuation when lung opacities appear.
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Affiliation(s)
- Chihiro Mimura
- Division of Respiratory Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
| | - Kazumi Kaneshiro
- Department of Respiratory MedicineKita‐Harima Medical CenterOno‐CityJapan
| | - Shodai Fujimoto
- Division of Respiratory Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan,Department of Respiratory MedicineAkashi Medical CenterAkashiJapan
| | - Ryota Dokuni
- Department of Respiratory MedicineHyogo Prefectural Awaji Medical CenterSumotoJapan
| | - Natsuhiko Iwamoto
- Department of Respiratory MedicineTakatsuki General HospitalOsakaJapan
| | - Kanoko Matsumura
- Department of Respiratory MedicineTakatsuki General HospitalOsakaJapan
| | | | - Yuko Kono
- Department of Respiratory MedicineKita‐Harima Medical CenterOno‐CityJapan
| | - Motoko Tachihara
- Division of Respiratory Medicine, Department of Internal MedicineKobe University Graduate School of MedicineKobeJapan
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12
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Tseng LW, Chang JWC, Wu CE. Safety of Tepotinib Challenge after Capmatinib-Induced Pneumonitis in a Patient with Non-Small Cell Lung Cancer Harboring MET Exon 14 Skipping Mutation: A Case Report. Int J Mol Sci 2022; 23:ijms231911809. [PMID: 36233109 PMCID: PMC9570266 DOI: 10.3390/ijms231911809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
The targeted agents capmatinib and tepotinib provide a new treatment for patients with non-small cell lung cancer (NSCLC) with MET exon 14 skipping mutation (METex14). However, drug-induced pneumonitis is an uncommon but threatening adverse effect found in patients treated with both capmatinib and tepotinib. The safety of treating a patient with a MET inhibitor after drug-induced pneumonitis by another MET inhibitor remains unclear. Here, we present a case of a patient with NSCLC harboring a METex14 who was treated with a standard dose of tepotinib after advanced capmatinib-induced pneumonitis and did not present pneumonitis relapse. Tepotinib may be a safe option when medical professionals consider switching MET inhibitors after patients experience pneumonitis.
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Affiliation(s)
- Liang-Wei Tseng
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan 33302, Taiwan
| | - John Wen-Cheng Chang
- Division of Haematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5, Fu-Hsing Street, Kwei-Shan, Taoyuan 33302, Taiwan
| | - Chiao-En Wu
- Division of Haematology-Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5, Fu-Hsing Street, Kwei-Shan, Taoyuan 33302, Taiwan
- Correspondence: ; Tel.: +886-3-3281200; Fax: +886-3-3278211
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13
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Shibaki R, Ozawa Y, Noguchi S, Murakami Y, Takase E, Azuma Y, Maebeya M, Sugimoto T, Hayata A, Hayakawa T, Tamaki S, Nakanishi M, Teraoka S, Akamatsu H. Impact of pre-existing interstitial lung abnormal shadow on lung injury development and severity in patients of non-small cell lung cancer treated with osimertinib. Cancer Med 2022; 11:3743-3750. [PMID: 35434933 PMCID: PMC9582680 DOI: 10.1002/cam4.4750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/06/2022] [Accepted: 04/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background First‐generation epidermal growth factor receptor‐tyrosine kinase inhibitor (EGFR‐TKI) sometimes causes lung injury, thereby affecting survival. Although pre‐existing interstitial lung abnormal shadow (pre‐ILS) increases the risk of lung injury by EGFR‐TKIs, its impact on osimertinib, a third‐generation EGFR‐TKI, remains unknown. Patients and Methods This retrospective cohort study consecutively enrolled patients of EGFR‐mutated non‐small cell lung cancer treated with osimertinib. Computed tomography images were obtained and evaluated independently by three pulmonologists in a blinded manner. Factors associated with lung injury were assessed using a logistic regression model. Survival curves were calculated by the Kaplan–Meier method and compared using a log‐rank test. Results Of the 195 patients, 40 had pre‐ILS, and 21 (8 with and 13 without pre‐ILS) developed lung injury during the observation period. Multivariate analysis revealed that pre‐ILS was independently associated with lung injury (odds ratio, 3.1; 95% confidence interval [CI], 1.1–8.2; p = 0.025). Severe (≥Grade 3) lung injury was observed in eight (4.1%) patients, of whom, two (5%) and six (3.9%) had and did not have pre‐ILS (p = 0.67), respectively. Grade 5 lung injury was not observed, and survival curves were similar between the patients who developed lung injury and those who did not (median 11 vs. 12 months; hazard ratio, 1.2; 95% CI, 0.56–2.7; p = 0.60). Conclusions Pre‐ILS increased the risk of lung injury in patients of non‐small cell lung cancer treated with osimertinib, while the severity of lung injury was not clearly affected by the presence of pre‐ILS.
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Affiliation(s)
- Ryota Shibaki
- Internal Medicine III, Wakayama Medical University, Wakayama, Japan
| | - Yuichi Ozawa
- Internal Medicine III, Wakayama Medical University, Wakayama, Japan
| | - Susumu Noguchi
- Respiratory Medicine, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yusuke Murakami
- Respiratory Medicine, National Hospital Organization Minami Wakayama Medical Center, Wakayama, Japan
| | - Eri Takase
- Department of Respiratory Medicine, Naga Municipal Hospital, Wakayama, Japan
| | - Yuichiro Azuma
- Respiratory Medicine, National Hospital Organization Wakayama Hospital, Wakayama, Japan
| | - Masaru Maebeya
- Respiratory Medicine, Wakayama Rosai Hospital, Wakayama, Japan
| | - Takeya Sugimoto
- Internal Medicine III, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Hayata
- Internal Medicine III, Wakayama Medical University, Wakayama, Japan
| | | | - Shinya Tamaki
- The Second Department of Internal Medicine, Hidaka General Hospital, Wakayama, Japan
| | | | - Shunsuke Teraoka
- Internal Medicine III, Wakayama Medical University, Wakayama, Japan
| | - Hiroaki Akamatsu
- Internal Medicine III, Wakayama Medical University, Wakayama, Japan
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14
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Le Guen Y, Lederlin M, Triquet L, Lesouhaitier M, Le Tulzo Y, Ricordel C. [Pulmonary manifestations induced by osimertinib]. Rev Mal Respir 2021; 39:62-66. [PMID: 34969538 DOI: 10.1016/j.rmr.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/21/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The third-generation tyrosine kinase inhibitor (TKI) osimertinib is recommended as a first-line treatment in advanced non-small cell lung cancer harboring an activating mutation of Epidermal Growth Factor Receptor (EGFR). Adverse pulmonary events related to osimertinib exposure have been reported, primarily in Japanese patients. They rarely occur in the Caucasian population. OBSERVATION Herein we report two clinical cases of osimertinib-induced lung toxicities in patients diagnosed with advanced lung adenocarcinoma harboring an EGFR mutation. In the first case, interstitial pneumonia was asymptomatic and evolved favorably after osimertinib discontinuation. The second patient presented a more extensive form of lung injuries and despite systemic corticosteroid therapy, the evolution was fatal. CONCLUSION Osimertinib-related lung toxicities remain exceptional. While most forms are mild, consideration of TKI treatment discontinuation may be necessitated. Introduction of another TKI or rechallenge with osimertinib might be considered along with corticosteroid therapy if necessary. Diffuse alveolar damage is a pejorative prognostic factor.
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Affiliation(s)
- Y Le Guen
- Service de pneumologie, université de Rennes-1, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France.
| | - M Lederlin
- Service de radiologie, hôpital Pontchaillou, université de Rennes 1, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - L Triquet
- Service de pharmacologie, centre régional de pharmacovigilance de pharmaco-épidémiologie et d'information sur le médicament, CHU Pontchaillou, 35033 Rennes, France
| | - M Lesouhaitier
- Service des maladies infectieuses et réanimation médicale, hôpital Pontchaillou, CHU Rennes, 2 rue Henri Le Guillloux, 35033 Rennes cedex 9, France
| | - Y Le Tulzo
- Service des maladies infectieuses et réanimation médicale, hôpital Pontchaillou, CHU Rennes, 2 rue Henri Le Guillloux, 35033 Rennes cedex 9, France
| | - C Ricordel
- Service de pneumologie, université de Rennes-1, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France; INSERM U1242, Chemistry Oncogenesis Stress and Signalling, CLCC Eugène Marquis, Rennes, France
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15
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[Osimertinib Re-challenge for EGFR-mutant NSCLC after
Osimertinib-induced Interstitial Lung Disease: A Case Report]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2021; 24:804-807. [PMID: 34802213 PMCID: PMC8607285 DOI: 10.3779/j.issn.1009-3419.2021.102.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Osimertinib-induced interstitial lung disease (ILD) is an uncommon, but fatal pulmonary toxicity in some patients. We report a case of a 64-year-old male with stage IV adeno-non-small cell lung cancer (NSCLC) harboring an exon 19 deletion in the epidermal growth factor receptor (EGFR) treated with osimertinib 80 mg/d for first-line targeted therapy. On day 60 after initiating treatment of osimertinib, the patient developed ILD. Osimertinib was discontinued immediately and oral prednisone 60 mg/d was initiated, ILD improved within 13 d. After balancing the risk and benefit, osimertinib was restarted concurrently with prednisone. The patient showed neither disease progression nor a recurrence of ILD for more than 16 months. Based on our case and literature review, retreatment with osimertinib under steroid coverage could be considered as an effective treatment option after careful risk-benefit assessment for patients with EGFR-mutant NSCLC.
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16
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Taronna G, Leonetti A, Gustavo Dall'Olio F, Rizzo A, Parisi C, Buti S, Bordi P, Brocchi S, Golfieri R, Ardizzoni A, Sverzellati N, Tiseo M. Transient asymptomatic pulmonary opacities and interstitial lung disease in EGFR-mutated non-small cell lung cancer treated with osimertinib. TUMORI JOURNAL 2021; 108:592-599. [PMID: 34585625 DOI: 10.1177/03008916211047888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Osimertinib is a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) approved as first-line therapy for advanced EGFR-mutated non-small cell lung cancer (NSCLC). Some osimertinib-related interstitial lung diseases (ILDs) were shown to be transient, called transient asymptomatic pulmonary opacities (TAPO)-clinically benign pulmonary opacities that resolve despite continued osimertinib treatment-and are not associated with the clinical manifestations of typical TKI-associated ILDs. METHODS In this multicentric study, we retrospectively analyzed 92 patients with EGFR-mutated NSCLC treated with osimertinib. Computed tomography (CT) examinations were reviewed by two radiologists and TAPO were classified according to radiologic pattern. We also analyzed associations between TAPO and patients' clinical variables and compared clinical outcomes (time to treatment failure and overall survival) for TAPO-positive and TAPO-negative groups. RESULTS TAPO were found in 18/92 patients (19.6%), with a median follow-up of 114 weeks. Median onset time was 16 weeks (range 6-80) and median duration time 14 weeks (range 8-37). The most common radiologic pattern was focal ground-glass opacity (54.5%). We did not find any individual clinical variable significantly associated with the onset of TAPO or significant difference in clinical outcomes between TAPO-positive and TAPO-negative groups. CONCLUSIONS TAPO are benign pulmonary findings observed in patients treated with osimertinib. TAPO variability in terms of CT features can hinder the differential diagnosis with either osimertinib-related mild ILD or tumor progression. However, because TAPO are asymptomatic, it could be reasonable to continue therapy and verify the resolution of the CT findings at follow-up in selected cases.
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Affiliation(s)
- Gianluca Taronna
- Scienze Radiologiche Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alessandro Leonetti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Alessandro Rizzo
- Medical Oncology Unit, University Hospital of Bologna, Bologna, Italy
| | - Claudia Parisi
- Medical Oncology Unit, University Hospital of Bologna, Bologna, Italy
| | - Sebastiano Buti
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Paola Bordi
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy
| | - Stefano Brocchi
- Department of Radiology, University Hospital of Bologna, Bologna, Italy
| | - Rita Golfieri
- Department of Radiology, University Hospital of Bologna, Bologna, Italy
| | - Andrea Ardizzoni
- Medical Oncology Unit, University Hospital of Bologna, Bologna, Italy.,Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy
| | - Nicola Sverzellati
- Scienze Radiologiche Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marcello Tiseo
- Medical Oncology Unit, University Hospital of Parma, Parma, Italy.,Department of Medicine and Surgery, University of Parma, Parma, Italy
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17
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Sato Y, Sekine A, Hagiwara E, Sato M, Yamaya T, Asaoka M, Higa K, Ikeda S, Baba T, Komatsu S, Iwasawa T, Ogura T. Successful treatment with afatinib following the failure of osimertinib rechallenge with osimertinib-induced interstitial lung disease: A case report. Respir Med Case Rep 2021; 33:101450. [PMID: 34401289 PMCID: PMC8349001 DOI: 10.1016/j.rmcr.2021.101450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 05/17/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022] Open
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.
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Affiliation(s)
- Yozo Sato
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Eri Hagiwara
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Midori Sato
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Takafumi Yamaya
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Masato Asaoka
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Katsuyuki Higa
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tomohisa Baba
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Shigeru Komatsu
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Tae Iwasawa
- Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
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18
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Wu L, Zhong W, Li A, Qiu Z, Xie R, Shi H, Lu S. Successful treatment of EGFR T790M-mutant non-small cell lung cancer with almonertinib after osimertinib-induced interstitial lung disease: a case report and literature review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:950. [PMID: 34350265 PMCID: PMC8263887 DOI: 10.21037/atm-21-2823] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/09/2021] [Indexed: 12/24/2022]
Abstract
Third-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) have revolutionized the standard treatment for EGFR T790M-positive non-small cell lung cancer (NSCLC). Osimertinib is one of the third-generation EGFR-TKIs and is currently the most advanced in clinical development. Interstitial lung disease (ILD) is a potentially fatal side effect of osimertinib use. Successful rechallenge with the second-generation TKI afatinib following osimertinib-induced ILD has been reported. However, few reports have discussed the safety and efficacy of third-generation TKI rechallenge in this patient population. In this paper, a case of lung adenocarcinoma is retrospectively analyzed, and the relevant literature is reviewed. The patient was initially diagnosed with early lung cancer, for which surgical treatment was performed. The postoperative diagnosis indicated stage IB (pT2N0M0) right lung adenocarcinoma. Genetic testing (amplification-refractory mutation system) revealed EGFR exon 19 deletion. More than 2 years after surgery, multiple metastases occurred in both lungs, so gefitinib (250 mg per day) was administered. However, 6 months after the start of gefitinib treatment, the tumor progressed. Lung tumor biopsy was performed for genetic testing (NGS) and an EGFR T790M mutation was observed. Subsequently, second-line treatment with osimertinib (80 mg per day) was given for 3 months. The evaluated response suggested a partial response (PR) with the occurrence of grade 3 ILD. Pemetrexed plus bevacizumab chemotherapy was subsequently administered, resulting in stable disease. However, following a severe drug reaction after six courses, the patient’s chemotherapy was discontinued. Another third-generation TKI, almonertinib (110 mg per day), was rechallenged based on no ILD having been reported in a phase I/II study of this drug. After 4 months of almonertinib administration and 6 months without ILD recurrence, partial remission was attained. This is the first report of successful treatment with almonertinib after osimertinib-induced ILD. The results suggested that almonertinib had a significant effect in patients with EGFR T790M mutation, with fewer side effects and better survival benefits for patients with advanced lung cancer.
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Affiliation(s)
- Longqiu Wu
- Department of Oncology, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Wenjuan Zhong
- Department of Oncology, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - An Li
- Department of Oncology, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Zhengang Qiu
- Department of Oncology, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Ruilian Xie
- Department of Oncology, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Huaqiu Shi
- Department of Oncology, First Affiliated Hospital of Gannan Medical University, Jiangxi, China
| | - Shun Lu
- Department of Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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