EGFR突变非小细胞肺癌患者奥希替尼诱导间质性肺疾病后奥希替尼再挑战:病例报道

Osimertinib Re-challenge for EGFR-mutant NSCLC after Osimertinib-induced Interstitial Lung Disease:A Case Report

奥希替尼诱导的间质性肺疾病(interstitial lung disease,ILD)是一种罕见的、致命的肺毒性疾病。我们报道1例64岁男性IV期肺腺癌患者,伴有表皮生长因子受体(epidermal growth factor receptor,EGFR)外显子19缺失,使用奥希替尼80 mg/d作为一线靶向治疗。奥希替尼开始治疗后第60天患者出现ILD。立即停用奥希替尼,并开始口服泼尼松60 mg/d,ILD在13 d内得到改善。权衡风险和获益后,再次开始奥希替尼与泼尼松治疗。奥希替尼治疗16个月以上,患者既没有疾病进展,也没有ILD复发。根据我们的病例和既往文献,在仔细评估EGFR突变非小细胞肺癌(non-small cell lung cancer,NSCLC)患者的风险及获益后,在类固醇激素辅助下再次使用奥希替尼可被视为一种有效的治疗选择。

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.