Osimertinib rechallenge under steroid protection following osimertinib-induced pneumonitis: three case studies

Area of Science:

• Oncology
• Pharmacology
• Pulmonology

Background:

• Osimertinib is a preferred first-line treatment for metastatic non-small cell lung cancer (NSCLC) with EGFR mutations.
• Drug-induced pneumonitis is a known adverse event associated with osimertinib therapy.
• Standard management for severe pneumonitis involves treatment discontinuation, corticosteroids, and often a switch to alternative therapies.

Observation:

• This case series reports on three patients who experienced osimertinib-induced pneumonitis.
• Patients were rechallenged with osimertinib, initially at a lower dose, under steroid (prednisolone) protection.
• One patient initially underwent rechallenge without steroids and experienced recurrent pneumonitis before successful rechallenge with steroid support.

Findings:

• Successful rechallenge with osimertinib was achieved in two out of three patients under prednisolone protection.
• The third patient, initially retreated without steroids, developed recurrent pneumonitis but later tolerated rechallenge with steroid cover.
• These cases suggest that rechallenging with osimertinib after recovery from pneumonitis is feasible in select patients.

Implications:

• Rechallenge with osimertinib may be a viable option for NSCLC patients with EGFR mutations who develop pneumonitis, particularly when alternative treatments are scarce.
• Concomitant corticosteroid therapy appears crucial in preventing pneumonitis flares during osimertinib rechallenge.
• Further investigation into the safety and efficacy of osimertinib rechallenge protocols is warranted.