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Shimbu K, Hisakane K, Kadoma N, Nishima S, Atsumi K, Seike M, Hirose T. Safety and Efficacy of Gefitinib Administration After Osimertinib-Induced Interstitial Lung Disease: A Six-Case Series. Onco Targets Ther 2024; 17:717-726. [PMID: 39234190 PMCID: PMC11371895 DOI: 10.2147/ott.s475836] [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: 06/27/2024] [Accepted: 08/23/2024] [Indexed: 09/06/2024] Open
Abstract
Purpose Osimertinib, a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor, is the standard treatment for patients with non-small cell lung cancer harboring EGFR mutations. Although the frequency of osimertinib-induced interstitial lung disease (osi-ILD) is high, the optimal cancer treatment after osi-ILD has not been established. This time, we focused on the safety and efficacy of gefitinib following osi-ILD. Case Presentation We experienced six cases (five women and one man; median age: 74 years) in which gefitinib was administered after osi-ILD. All six cases had grade 2 or higher osi-ILD and required steroid treatment. The computed tomography imaging pattern of osi-ILD revealed organizing pneumonia in three cases, diffuse alveolar damage in two cases, and hypersensitivity pneumonia in one case. Eastern Cooperative Oncology Group performance status was 1 in four cases, 2 in one case, and 3 in one case. EGFR mutation status was exon 19 deletion in two cases and exon 21 L858R in four cases. Only one patient experienced recurrence of ILD after receiving gefitinib. The best response to gefitinib was partial response in two cases and stable disease in three cases; one case was not evaluable. The median progression-free survival after treatment with gefitinib was 190 days (95% confidence interval: 33-328). Conclusion The treatment with gefitinib after the development of osi-ILD was safe and effective. Gefitinib may be a promising option for patients who recovered from severe osi-ILD.
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Affiliation(s)
- Kaoruko Shimbu
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School, Tama Nagayama Hospital, Tokyo, 206-8512, Japan
| | - Kakeru Hisakane
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School, Tama Nagayama Hospital, Tokyo, 206-8512, Japan
| | - Naohiro Kadoma
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School, Tama Nagayama Hospital, Tokyo, 206-8512, Japan
| | - Shunichi Nishima
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School, Tama Nagayama Hospital, Tokyo, 206-8512, Japan
| | - Kenichiro Atsumi
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School, Tama Nagayama Hospital, Tokyo, 206-8512, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, 113-8603, Japan
| | - Takashi Hirose
- Department of Pulmonary Medicine and Medical Oncology, Nippon Medical School, Tama Nagayama Hospital, Tokyo, 206-8512, Japan
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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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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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4
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Saito Z, Imakita T, Ito T, Oi I, Kanai O, Fujita K, Tachibana H, Mio T. Successful Rechallenge with Osimertinib following Osimertinib-Induced Ventricular Tachycardia: A Case Report. Case Rep Oncol 2023; 16:1100-1106. [PMID: 37900846 PMCID: PMC10601787 DOI: 10.1159/000533826] [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: 05/03/2023] [Accepted: 08/24/2023] [Indexed: 10/31/2023] Open
Abstract
Osimertinib, a third-generation tyrosine kinase inhibitor, is the first-line treatment for metastatic non-small cell lung cancer (NSCLC) with sensitizing epidermal growth factor receptor (EGFR) mutations. It is known to cause drug-induced cardiotoxicity, including QT prolongation syndrome, heart failure, and ventricular arrhythmias, which can lead to sudden death. Once severe arrhythmias occur, it is difficult to continue osimertinib treatment. We report a case of a 66-year-old woman with recurrent NSCLC after concurrent chemoradiotherapy who experienced osimertinib-induced ventricular arrhythmia-causing syncope. The patient was initially treated with concurrent chemoradiotherapy, and genetic testing revealed EGFR exon 19 deletion. Three years following treatment initiation, the primary tumor progressed, and new bone metastases developed. The patient was diagnosed with recurrent NSCLC and was treated with targeted therapy with osimertinib. On the 10th day of osimertinib administration, syncope occurred. Electrocardiography showed polymorphic non-sustained ventricular tachycardia, which was believed to be the cause of syncope. The patient was switched to erlotinib. Two and a half years later, disease progression in the primary lesion was observed. A liquid biopsy revealed an EGFR T790M resistance mutation. Therefore, osimertinib (40 mg) was administered every alternate day. After confirming the absence of palpitations and arrhythmias on electrocardiogram, the osimertinib dosing was increased to 40 mg daily. Thereafter, no further events occurred, and tumor shrinkage was observed. Low-dose osimertinib rechallenge after induced ventricular arrhythmia may be considered an option under close monitoring; however, osimertinib rechallenge must be carefully selected based on the risk-benefit analysis.
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Affiliation(s)
- Zentaro Saito
- Division of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takuma Imakita
- Division of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takanori Ito
- Division of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Issei Oi
- Division of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Osamu Kanai
- Division of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kohei Fujita
- Division of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Hiromasa Tachibana
- Division of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Tadashi Mio
- Division of Respiratory Medicine, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
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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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6
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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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7
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Bickert C, Kahnert K, Kauffmann-Guerrero D, Götschke J, Syunyaeva Z, Behr J, Tufman A. Osimertinib rechallenge under steroid protection following osimertinib-induced pneumonitis: three case studies. Ther Adv Med Oncol 2021; 13:17588359211018028. [PMID: 34178120 PMCID: PMC8202262 DOI: 10.1177/17588359211018028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/23/2021] [Indexed: 11/22/2022] Open
Abstract
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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Affiliation(s)
- Christiane Bickert
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research, Klinikum Großhadern, Marchioninistr, 15, Munich, Bavaria 81377, Germany
| | - Kathrin Kahnert
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research, Munich, Bavaria, Germany
| | - Diego Kauffmann-Guerrero
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research, Munich, Bavaria, Germany
| | - Jeremias Götschke
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research, Munich, Bavaria, Germany
| | - Zulfiya Syunyaeva
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research, Munich, Bavaria, Germany
| | - Jürgen Behr
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research, Munich, Bavaria, Germany
| | - Amanda Tufman
- Department of Medicine V, University Hospital, LMU Munich, Member of the German Center for Lung Research, Munich, Bavaria, Germany
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8
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Retrospective analysis of osimertinib re-challenge after osimertinib-induced interstitial lung disease in patients with EGFR-mutant non-small cell lung carcinoma. Invest New Drugs 2020; 39:571-577. [PMID: 32955628 DOI: 10.1007/s10637-020-01005-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/15/2020] [Indexed: 12/26/2022]
Abstract
Osimertinib is a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) that has exhibited efficacy in patients with EGFR-mutant non-small cell lung cancer (NSCLC). Interstitial lung disease (ILD) is a fatal adverse event of osimertinib treatment, and it requires treatment discontinuation. There are few reports regarding the safety and efficacy of osimertinib re-challenge in patients who experienced osimertinib-induced ILD. This retrospective study assessed this treatment option. We retrospectively collected data for patients treated with osimertinib who developed ILD at Shizuoka Cancer Center from April 2016 to March 2020. ILD was diagnosed by two doctors based on imaging tests and blood tests to exclude other causes. Among 215 patients treated with osimertinib, 28 developed ILD. The median age of patients with ILD was 69.5 years (range, 39.0-80.0). In addition, 29% of patients were men, and 46% had a history of smoking. Eleven patients were re-administered EGFR TKIs, including eight patients treated with osimertinib and three patients treated with alternative EGFR TKIs. Among patients re-challenged with osimertinib, none who previously experienced grade 1 ILD exhibited ILD relapse, even with the same osimertinib dose and without the concurrent administration of systemic steroids. Meanwhile, one of the four patients who previously exhibited grade 2 ILD experienced despite a dose reduction for osimertinib and systemic steroid administration. For patients with EGFR-mutant NSCLC who experience grade 1 ILD during osimertinib therapy, osimertinib re-challenge may be suitable when no other treatments are available.
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9
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Ahn JH. Successful osimertinib retreatment after extremely early onset severe pneumonitis in first-line treatment of lung adenocarcinoma. Thorac Cancer 2020; 11:2713-2716. [PMID: 32666714 PMCID: PMC7471046 DOI: 10.1111/1759-7714.13565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/16/2020] [Accepted: 06/17/2020] [Indexed: 11/26/2022] Open
Abstract
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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Affiliation(s)
- June Hong Ahn
- Division of Pulmonology and Allergy, Department of Internal Medicine, College of Medicine, Yeungnam University and Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, South Korea
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10
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Lu H, Dowell J. Osimertinib in Pulmonary Manifestations: Two Case Reports and Review of the Literature. In Vivo 2020; 34:315-319. [PMID: 31882494 DOI: 10.21873/invivo.11776] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 12/21/2022]
Abstract
Osimertinib is an oral, irreversible epidermal growth factor receptor inhibitor that is associated with various pulmonary manifestations including transient asymptomatic pulmonary opacities (TAPOs) and pneumonitis. We present a case of a 61-year-old female with Stage IV lung adenocarcinoma, who developed bilateral ground glass opacities on her chest-computed tomography (CT) three months after initiating osimertinib. Her imaging findings were thought to represent lymphangitic carcinomatosis responding to chemotherapy rather than drug induced toxicity, and she was continued on osimertinib. Conversely, we present a second case of a 57-year-old female with Stage IV lung adenocarcinoma who developed osimertinib-induced pneumonitis and was successfully rechallenged with osimertinib and glucocorticoids. These cases, described herein, illustrate examples of the range of pulmonary manifestations of osimertinib, as well as the safety of rechallenging patients with osimertinib and glucocorticoids following the development of pneumonitis.
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Affiliation(s)
- Hannah Lu
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A.
| | - Jonathan Dowell
- Veterans Affairs North Texas Healthcare System, Dallas, TX and Division of Hematology/Oncology, University of Texas Southwestern Medical Center, Dallas, TX, U.S.A
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11
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Harada G, Santini FC, Canedo FSNA, de Carvalho Oliveira LJ, Zuppani HB, De Castro G. Successful osimertinib rechallenge following drug-induced pneumonitis after previous anti-PDL1 exposure. Ecancermedicalscience 2020; 13:970. [PMID: 31921341 PMCID: PMC6834382 DOI: 10.3332/ecancer.2019.970] [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: 07/02/2019] [Indexed: 11/30/2022] Open
Abstract
Osimertinib is a first-line treatment option for patients with metastatic non-small cell lung cancer (NSCLC) harbouring EGFR mutations. Pneumonitis is a severe adverse event (AE) related to osimertinib treatment which appears to be more frequent when associated with concurrent or previous anti-PD(L)1 exposure. Data regarding the efficacy and safety of osimertinib rechallenge, especially in the setting of central nervous system (CNS) metastases, are scarce. We herein describe a case of a 53-year-old patient with metastatic EGFR-mutated NSCLC, who developed pneumonitis after osimertinib treatment and was successfully rechallenged with 40 mg daily osimertinib, with CNS response. This dose reduction strategy may be an option for selected patients with brain metastases after tyrosine kinase inhibitors-induced AEs.
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12
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Syunyaeva Z, Berghof K, Kauffmann-Guerrero D, Götschke J, Tufman A, Kahnert K. Late-onset severe pneumonitis under osimertinib. AME Case Rep 2019; 3:39. [PMID: 31728437 DOI: 10.21037/acr.2019.09.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 09/16/2019] [Indexed: 12/30/2022]
Abstract
Pneumonitis is a rare and possibly life threatening side effect of TKI-treatment. We present a patient with adenocarcinoma of the lung harboring an uncommon EGFR Exon 21 mutation treated with osimertinib as second-line therapy. After nine months of treatment, the patient developed progressing shortness of breath and night sweats. A severe late-onset predominantly eosinophilic pneumonitis was diagnosed, osimertinib treatment was discontinued and immunosuppressive treatment was initiated. This case report highlights late-onset pneumonitis as a side effect of third-generation TKI-treatment and possible options for subsequent tumor treatment.
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Affiliation(s)
- Zulfiya Syunyaeva
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, University of Munich (LMU), Thoracic Oncology Centre Munich, Munich, Germany.,Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Katharina Berghof
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, University of Munich (LMU), Thoracic Oncology Centre Munich, Munich, Germany.,Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Diego Kauffmann-Guerrero
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, University of Munich (LMU), Thoracic Oncology Centre Munich, Munich, Germany.,Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Jeremias Götschke
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, University of Munich (LMU), Thoracic Oncology Centre Munich, Munich, Germany.,Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Amanda Tufman
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, University of Munich (LMU), Thoracic Oncology Centre Munich, Munich, Germany.,Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Kathrin Kahnert
- Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, University of Munich (LMU), Thoracic Oncology Centre Munich, Munich, Germany.,Comprehensive Pneumology Center, Member of the German Center for Lung Research (DZL), Munich, Germany
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13
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Wang H, Zhang L, Shi X, Zhang X, Si X. Successful treatment with osimertinib and its subsequent resistance mechanism in a patient with non-small-cell lung cancer harboring acquired EGFR T790M mutation after recovery from AC0010-induced interstitial lung disease. Onco Targets Ther 2019; 12:5545-5549. [PMID: 31371992 PMCID: PMC6628610 DOI: 10.2147/ott.s204689] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 06/17/2019] [Indexed: 01/10/2023] Open
Abstract
Objective Treatment with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs)can occasionally lead to interstitial lung disease (ILD), and the appropriate treatment after recovery from ILD remains controversial. AC0010 is an investigational third-generation TKI used in China to selectively target the T790M mutation. Here, we describe a patient who developed ILD after AC0010 treatment and was then successfully re-challenged with osimertinib. Methods The patient was a 67-year-old male with a diagnosis of metastatic pulmonary adenocarcinoma with an L858R mutation on exon 21. Acquired T790M mutation was confirmed by re-biopsy after progression on erlotinib treatment. The patient was treated with AC0010, and developed ILD 54 days after treatment initiation. Following his recovery from ILD, osimertinib (80 mg/day) was administered with no adverse effects. After progression on osimertini\b 11 months later, a histological transformation from adenocarcinoma to large-cell neuroendocrine carcinoma was confirmed by re-biopsy, with a marked increase in serum neuron-specific enolase. Conclusions This is the first report of interstitial pneumonitis caused by AC0010. Osimertinib re-challenge after recovery from ILD was a safe and effective treatment option. Our report further highlights that pathological transformation of large-cell neuroendocrine carcinoma represents one of the resistance mechanisms of osimertinib, and may be accompanied by an increase in serum neuron-specific enolase.
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Affiliation(s)
- Hanping Wang
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Li Zhang
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Xiaohua Shi
- Department of Pathology, Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Xiaotong Zhang
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
| | - Xiaoyan Si
- Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing 100730, People's Republic of China
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14
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Shah RR, Shah DR. Safety and Tolerability of Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitors in Oncology. Drug Saf 2019; 42:181-198. [PMID: 30649743 DOI: 10.1007/s40264-018-0772-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Tyrosine kinase inhibitors (TKIs) that target epidermal growth factor receptor (EGFR) have dramatically improved progression-free survival in non-small-cell lung cancer (NSCLC) patients who carry sensitizing EGFR-activating mutations and in patients with breast and pancreatic cancers. However, EGFR-TKIs are associated with significant and disabling undesirable effects that adversely impact on quality of life and compliance. These effects include dermatological reactions, diarrhoea, hepatotoxicity, stomatitis, interstitial lung disease and ocular toxicity. Each individual EGFR-TKI is also associated with additional adverse effect(s) that are not shared widely by the other members of its class. Often, these effects call for dose reduction, treatment discontinuation or pharmacotherapeutic intervention. Since dermatological effects result from on-target effects on wild-type EGFR, rash is often considered to be a biomarker of efficacy. A number of studies have reported better outcomes in patients with skin reactions compared with those without. This has led to a 'dosing-to-rash' strategy to optimize therapeutic outcomes. Although conceptually attractive, there is currently insufficient evidence-based support for this strategy. While skin reactions following EGFR-TKIs are believed to result from an effect on wild-type EGFR, their efficacy is related to effects on mutant variants of EGFR. It is noteworthy that newer EGFR-TKIs that spare wild-type EGFR are associated with fewer dermatological reactions. Furthermore, secondary mutations such as T790M in exon 20 often lead to development of resistance to the clinical activity and efficacy of first- and second-generation EGFR-TKIs. This has stimulated the search for later-generations of EGFR-TKIs with the ability to overcome this resistance and with greater target selectivity to spare wild-type EGFR in expectations of an improved safety profile. However, available data reviewed herein indicate that not only are these newer agents associated with the aforementioned adverse effects typical of earlier agents, but they are also susceptible to resistance due to tertiary mutations, most frequently C797S. At least three later-generation EGFR-TKIs, canertinib, naquotinib and rociletinib, have been discontinued from further development in NSCLC following concerns about their safety and risk/benefit.
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