Osimertinib‑induced interstitial lung disease in a patient with non‑small cell lung cancer pretreated with nivolumab: A case report

Takakuwa,Osamu; Oguri,Tetsuya; Uemura,Takehiro; Sone,Kazuki; Fukuda,Satoshi; Okayama,Minami; Kanemitsu,Yoshihiro; Ohkubo,Hirotsugu; Takemura,Masaya; Ito,Yutaka; Maeno,Ken; Niimi,Akio

doi:10.3892/mco.2017.1349

Osimertinib‑induced interstitial lung disease in a patient with non‑small cell lung cancer pretreated with nivolumab: A case report

Authors:
- Osamu Takakuwa
- Tetsuya Oguri
- Takehiro Uemura
- Kazuki Sone
- Satoshi Fukuda
- Minami Okayama
- Yoshihiro Kanemitsu
- Hirotsugu Ohkubo
- Masaya Takemura
- Yutaka Ito
- Ken Maeno
- Akio Niimi
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Affiliations: Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi 467‑8601, Japan
Published online on: July 25, 2017 https://doi.org/10.3892/mco.2017.1349
Pages: 383-385

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Abstract

Osimertinib (AZD9291) is a third‑generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor approved for EGFR‑T790M‑positive non‑small cell lung cancer. A high incidence of interstitial lung disease (ILD) during combination treatment with osimertinib and anti‑programmed cell death‑ligand 1 (PD‑L1) inhibitor has been reported. The current study presents a case of ILD development during osimertinib treatment following nivolumab (an anti‑PD‑1 antibody) treatment. The 59‑year‑old female was diagnosed with stage IV lung adenocarcinoma harboring a deletion in exon 19 of the EGFR gene. Following nivolumab as a sixth‑line treatment, an EGFR‑T790M‑encoding mutation in EGFR exon 20 was identified by re‑biopsy. Osimertinib was therefore initiated as a seventh‑line treatment. A partial response was subsequently noted; however, 63 days after initiation of the treatment the patient presented with dyspnea with decreased oxygenation in the absence of fever and sputum. A computed tomography scan revealed the emergence of ground‑glass opacities with bronchiectasis in both lungs, and a diagnosis of ILD due to osimertinib was made. Following steroid pulse therapy with discontinuation of osimertinib, the patient's chest findings and respiratory condition improved. Therefore, it is considered that anti‑PD‑1 therapies may be associated with a risk of ILD during subsequent osimertinib treatment.

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1	Jänne PA, Yang JC, Kim DW, Planchard D, Ohe Y, Ramalingam SS, Ahn MJ, Kim SW, Su WC, Horn L, et al: AZD9291 in EGFR inhibitor-resistant non-small cell lung cancer. N Engl J Med. 372:1689–1699. 2015. View Article : Google Scholar : PubMed/NCBI
2	Brahmer J, Reckamp KL, Baas P, Crinò L, Eberhardt WE, Poddubskaya E, Antonia S, Pluzanski A, Vokes EE, Holgado E, et al: Nivolumab versus docetaxel in advanced squamous-cell non-small cell lung cancer. N Engl J Med. 373:123–135. 2015. View Article : Google Scholar : PubMed/NCBI
3	Mok TS, Wu YL, Thongprasert S, Yang CH, Chu DT, Saijo N, Sunpaweravong P, Han B, Margono B, Ichinose Y, et al: Gefitinib or carboplatin-paclitaxel in pulmonary adenocarcinoma. N Engl J Med. 361:947–957. 2009. View Article : Google Scholar : PubMed/NCBI
4	Maemondo M, Inoue A, Kobayashi K, Sugawara S, Oizumi S, Isobe H, Gemma A, Harada M, Yoshizawa H, Kinoshita I, et al: Gefitinib or chemotherapy for non-small-cell lung cancer with mutated EGFR. N Engl J Med. 362:2380–2388. 2010. View Article : Google Scholar : PubMed/NCBI
5	Rosell R, Carcereny E, Gervais R, Vergnenegre A, Massuti B, Felip E, Palmero R, Garcia-Gomez R, Pallares C, Sanchez JM, et al: Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): A multicentre, open-label, randomised phase 3 trial. Lancet Oncol. 13:239–246. 2012. View Article : Google Scholar : PubMed/NCBI
6	Sequist LV, Yang JC, Yamamoto N, O'Byrne K, Hirsh V, Mok T, Geater SL, Orlov S, Tsai CM, Boyer M, et al: Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol. 31:3327–3334. 2013. View Article : Google Scholar : PubMed/NCBI
7	Yu HA, Arcila ME, Rekhtman N, Sima CS, Zakowski MF, Pao W, Kris MG, Miller VA, Ladanyi M and Riely GJ: Analysis of tumor specimens at the time of acquired resistance to EGFR-TKI therapy in 155 patients with EGFR-mutant lung cancers. Clin Cancer Res. 19:2240–2247. 2013. View Article : Google Scholar : PubMed/NCBI
8	Hotta K, Kiura K, Takigawa N, Yoshioka H, Harita S, Kuyama S, Yonei T, Fujiwara K, Maeda T, Aoe K, et al: Comparison of the incidence and pattern of interstitial lung disease during erlotinib and gefitinib treatment in Japanese Patients with non-small cell lung cancer: The Okayama Lung Cancer Study Group experience. J Thorac Oncol. 5:179–184. 2010. View Article : Google Scholar : PubMed/NCBI
9	Ahn MJ, Yang J, Yu H, Saka H, Ramalingam S, Goto K, Kim SW, Yang L, Walding A and Oxnard GR: 136O: Osimertinib combined with durvalumab in EGFR-mutant non-small cell lung cancer: Results from the TATTON phase Ib trial. J Thorac Oncol. 11:S1152016. View Article : Google Scholar : PubMed/NCBI
10	Gibbons DL, Chow LQ, Kim DW, Kim SW, Yeh T, Song X, Jiang H, Taylor R, Karakunnel J and Creelan B: 570 Efficacy, safety and tolerability of MEDI4736 (durvalumab [D]), a human IgG1 anti-programmed cell death-ligand-1 (PD-L1) antibody, combined with gefitinib (G): A phase I expansion in TKI-naïve patients (pts) with EGFR mutant NSCLC. J Thorac Oncol. 11:S792016. View Article : Google Scholar : PubMed/NCBI
11	Gettinger SN, Horn L, Gandhi L, Spigel DR, Antonia SJ, Rizvi NA, Powderly JD, Heist RS, Carvajal RD, Jackman DM, et al: Overall survival and long-term safety of nivolumab (anti-programmed death 1 Antibody, BMS-936558, ONO-4538) in patients with previously treated advanced non-small-cell lung cancer. J Clin Oncol. 33:2004–2012. 2015. View Article : Google Scholar : PubMed/NCBI
12	Lee CK, Man J, Lord S, Links M, Gebski V, Mok T and Yang JC: Checkpoint inhibitors in metastatic EGFR-mutated non-small cell lung cancer-A meta-analysis. J Thorac Oncol. 12:403–407. 2017. View Article : Google Scholar : PubMed/NCBI
13	Zhang T, Xie J, Arai S, Wang L, Shi X, Shi N, Ma F, Chen S, Huang L, Yang L, et al: The efficacy and safety of anti-PD-1/PD-L1 antibodies for treatment of advanced or refractory cancers: A meta-analysis. Oncotarget. 7:73068–73079. 2016.PubMed/NCBI