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Osimertinib-induced severe bilateral pneumothorax: A case report
He Li1, Xiaojuan Shi, Gang Chen
1Department of Respiration, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Rationale:
Osimertinib is the third-generation, pyrimidine-based, irreversible epidermal growth factor receptor-tyrosine kinase inhibitor that received approval from the FDA in November 2015 and has become the standard approach in patients with advanced, epidermal growth factor receptor (EGFR) mutated non-small cell lung cancer (NSCLC), especially with brain metastases. Osimertinib is beneficial in terms of progression-free and overall survival in patients with EGFR-mutated NSCLC. However, the rarity of bilateral pneumothorax among adverse events necessitates further research on its potential fatality rate.
Patient Concerns:
A 72-year-old man diagnosed with stage IV (T2NxM1) NSCLC with the 21L858R mutation of the EGFR gene received osimertinib treatment. Unfortunately, 10 weeks after osimertinib treatment, the patient developed severe interstitial lung disease and pneumothorax. Thus, osimertinib treatment was discontinued, and prednisolone (160 mg/day) and supportive treatment were administered.
Diagnoses:
Osimertinib-induced severe interstitial lung disease and pneumothorax.
Interventions:
Osimertinib treatment was discontinued, and prednisolone (160 mg/day) and supportive treatment were administered.
Outcomes:
The bilateral pneumothorax was difficult to correct and the patient eventually died.
Lessons:
Osimertinib-induced pneumothorax occurred approximately 10 weeks after receiving the drug and had severe cough and chest tightness as initial symptoms. In addition, the incidence of drug-induced pneumothorax increases in patients treated with osimertinib when combined with underlying respiratory diseases.
Insights
Osimertinib, a treatment for EGFR-mutated NSCLC, can cause rare but fatal bilateral pneumothorax. This adverse event, presenting with cough and chest tightness, may be more common in patients with pre-existing respiratory conditions.
Area of Science:
- Oncology
- Pulmonology
- Pharmacology
Background:
- Osimertinib is a third-generation EGFR-TKI standard for advanced NSCLC, particularly with brain metastases.
- It improves progression-free and overall survival in EGFR-mutated NSCLC patients.
- The potential fatality rate of rare adverse events like bilateral pneumothorax requires further investigation.
Observation:
- A 72-year-old male with stage IV NSCLC (EGFR 21L858R mutation) received osimertinib.
- Ten weeks post-treatment initiation, the patient developed severe interstitial lung disease and pneumothorax.
- Initial symptoms included severe cough and chest tightness.
Findings:
- Bilateral pneumothorax was difficult to manage, leading to patient mortality.
- Osimertinib treatment was discontinued, and supportive care with prednisolone was initiated.
- Drug-induced pneumothorax incidence may increase with underlying respiratory conditions.
Implications:
- This case highlights the severe, potentially fatal risk of osimertinib-induced pneumothorax.
- Early recognition of symptoms like cough and chest tightness is crucial for prompt intervention.
- Caution is advised when prescribing osimertinib to NSCLC patients with pre-existing respiratory diseases.
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