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Intestinal Haemorrhage and Colitis Induced by Treatment With Osimertinib for Non-Small-Cell Lung Carcinoma: A Case
Wang Shujun1, Lou Lili2, Yang Lei3
1Department of Gastroenterology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Abstract:
Background: Osimertinib is recommended either as the first-line therapy for sensitizing EGFR-mutations (FLAURA trial) or at progression to first-/second-generation EGFR inhibitors in the presence of resistance mutation T790M (AURA 3 study). It can effectively improve the prognosis of patients with NSCLC with manageable adverse reactions. Among adverse events, intestinal haemorrhage is rare and requires extensive study on its potential lethality. Case presentation: A 59-year-old female, diagnosed with relapsed stage IV (cT4N2M1c) NSCLC with T790M mutation of the EGFR gene, received osimertinib treatment. Eight months after osimertinib treatment, she complained of lower abdominal pain and haematochezia without haemorrhoids. Potential causes of intestinal haemorrhage other than osimertinib toxicity were ruled out. Colonoscopy examination showed severe colitis with grade 3 CTCAE. Osimertinib was discontinued, and prednisone 0.5 mg/kg was administered. Follow-up endoscopy showed no pathological findings. A novel third-generation EGFR-TKI, aumolertinib, was administrated. Five months after aumolertinib initiation, CT evaluation showed stable disease (SD), and this patient was free of colitis recurrence. Conclusion: To our knowledge, this is the first case report of severe colitis as an adverse event associated with osimertinib. Although osimertinib is the standard treatment for NSCLC in patients with T790M mutation and has fewer side effects, colitis may occur after months of treatment. Aumolertinib, a novel third-generation EGFR-TKI, might be an effective alternative for the treatment of patients with NSCLC experiencing colitis from osimertinib.
Insights
Osimertinib, a treatment for non-small cell lung cancer (NSCLC), can cause severe colitis. Aumolertinib, another EGFR-TKI, may be a safe alternative for patients experiencing this adverse event.
Area of Science:
- Oncology
- Pharmacology
- Gastroenterology
Background:
- Osimertinib is a standard treatment for EGFR-mutated non-small cell lung cancer (NSCLC), used first-line or at T790M resistance mutation progression.
- While generally well-tolerated, rare but severe adverse events like intestinal hemorrhage require further investigation.
- This report focuses on a specific gastrointestinal toxicity associated with osimertinib therapy.
Observation:
- A 59-year-old female with relapsed stage IV NSCLC and EGFR T790M mutation developed severe colitis (Grade 3 CTCAE) eight months into osimertinib treatment.
- Symptoms included lower abdominal pain and hematochezia, with other causes of intestinal bleeding ruled out.
- Discontinuation of osimertinib and corticosteroid treatment led to resolution of colitis symptoms.
Findings:
- This case represents the first reported instance of severe colitis as an adverse event linked to osimertinib therapy.
- The patient was subsequently treated with aumolertinib, a novel third-generation EGFR-TKI, which was well-tolerated.
- Stable disease was maintained on aumolertinib without recurrence of colitis.
Implications:
- Severe colitis, though rare, is a potential adverse event of osimertinib therapy in NSCLC patients.
- Aumolertinib demonstrates potential as an effective and safer alternative for NSCLC patients who develop colitis while on osimertinib.
- This case highlights the importance of monitoring for and managing rare toxicities associated with targeted cancer therapies.
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