[Pulmonary manifestations induced by osimertinib]

Area of Science:

• Oncology
• Pulmonology
• Pharmacology

Background:

• Osimertinib, a third-generation tyrosine kinase inhibitor (TKI), is a first-line treatment for advanced non-small cell lung cancer (NSCLC) with EGFR mutations.
• Adverse pulmonary events associated with osimertinib are reported, predominantly in Japanese patients, and are rare in Caucasian populations.

Purpose of the Study:

• To report two clinical cases of osimertinib-induced lung toxicities in patients with advanced EGFR-mutated lung adenocarcinoma.
• To highlight the spectrum of osimertinib-related pulmonary adverse events and their management.

Main Methods:

• Case report of two patients with advanced lung adenocarcinoma and EGFR mutations treated with osimertinib.
• Clinical observation of pulmonary adverse events, treatment interventions, and patient outcomes.

Main Results:

• The first patient experienced asymptomatic interstitial pneumonia that resolved favorably upon osimertinib discontinuation.
• The second patient developed extensive lung injuries, which were fatal despite systemic corticosteroid therapy.

Conclusions:

• Osimertinib-related lung toxicities are exceptional but can range from mild to severe.
• Discontinuation of osimertinib, corticosteroid therapy, and consideration of alternative TKIs or rechallenge are potential management strategies.
• Diffuse alveolar damage is associated with a poor prognosis in osimertinib-induced lung toxicity.