Interstitial Lung Disease Induced by Osimertinib for Epidermal Growth Factor Receptor (EGFR) T790M-positive Non-small Cell Lung Cancer

Intern Med. 2017 Sep 1;56(17):2325-2328. doi: 10.2169/internalmedicine.8467-16. Epub 2017 Aug 10.

Abstract

A 75-year-old man with stage IV lung adenocarcinoma was treated with osimertinib due to disease progression despite having been administered erlotinib. Both an epidermal growth factor receptor (EGFR) L858R mutation on exon 21 and a T790M mutation on exon 20 were detected in a specimen from a recurrent primary tumor. Five weeks after osimertinib initiation, he developed general fatigue and dyspnea. Chest computed tomography scan revealed diffuse ground glass opacities and consolidation on both lungs. An analysis of the bronchoalveolar lavage fluid revealed marked lymphocytosis, and a transbronchial lung biopsy specimen showed a thickened interstitium with fibrosis and prominent lymphocytic infiltration. We diagnosed the patient to have interstitial lung disease induced by osimertinib.

Keywords: T790M resistance mutation; epidermal growth factor receptor; interstitial lung disease; non-small cell lung cancer; osimertinib; transbronchial lung biopsy.

Publication types

  • Case Reports

MeSH terms

  • Acrylamides
  • Adenocarcinoma / drug therapy*
  • Adenocarcinoma / pathology
  • Adenocarcinoma of Lung
  • Aged
  • Aniline Compounds
  • Antineoplastic Agents / therapeutic use*
  • Carcinoma, Non-Small-Cell Lung / drug therapy*
  • Carcinoma, Non-Small-Cell Lung / pathology
  • ErbB Receptors / genetics
  • Erlotinib Hydrochloride / therapeutic use
  • Humans
  • Lung Diseases, Interstitial / chemically induced*
  • Lung Diseases, Interstitial / drug therapy*
  • Lung Neoplasms / drug therapy*
  • Lung Neoplasms / pathology
  • Male
  • Neoplasm Recurrence, Local / drug therapy
  • Piperazines / adverse effects*
  • Protein Kinase Inhibitors / therapeutic use

Substances

  • Acrylamides
  • Aniline Compounds
  • Antineoplastic Agents
  • Piperazines
  • Protein Kinase Inhibitors
  • osimertinib
  • Erlotinib Hydrochloride
  • EGFR protein, human
  • ErbB Receptors