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Oral lichenoid drug eruption due to osimertinib for lung cancer
Ruba Alchaikh Hassan1, Abram Soliman1, Constantin A Dasanu2,3
1Department of Internal Medicine, Eisenhower Health, Rancho Mirage, CA, USA.
Introduction:
Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR) are linked with side effects involving skin and mucosa. Herein, we present a unique case of oral lichenoid drug eruption (LDE) in a patient treated with osimertinib.
Case Report:
A 75-year-old woman was diagnosed with metastatic EGFR-mutated lung adenocarcinoma, and started on osimertinib 80 mg PO daily. At 24 months of therapy, the patient developed a painful, red, and white striated oral lesion involving the left buccal mucosa and the adjacent buccal aspect of gingivae. Biopsy showed oral LDE. Causality assessment between osimertinib and the oral LDE via Naranjo Adverse Drug Reaction probability scale revealed a score of 5.
Management And Outcome:
Osimetinib discontinuation was not felt to be in the best interest of the patient. Therefore, diphenhydramine HCL mouthwash every 6 h PRN (before meals) was started. Spicy and hot foods were discontinued. At a four-week follow-up visit, the patient reported moderate improvement in her symptoms.
Conclusion:
Oral LDEs are considered premalignant lesions as they can transform into squamous cell carcinoma; therefore, regular follow-up is needed. Awareness of this potential side effect of osimertinib would also prevent unnecessary (and potentially costly) work-up and lead to its prompt diagnosis and treatment.
Insights
Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR) can cause oral lichenoid drug eruptions (LDE). This case highlights a patient treated with osimertinib who developed oral LDE, emphasizing the need for awareness and prompt management.
Area of Science:
- Oncology
- Dermatology
- Pharmacology
Background:
- Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are associated with mucocutaneous side effects.
- Osimertinib is a third-generation EGFR-TKI used for EGFR-mutated lung adenocarcinoma.
Observation:
- A 75-year-old woman on osimertinib developed a painful oral lesion.
- Biopsy confirmed oral lichenoid drug eruption (LDE).
- Naranjo scale indicated a probable link between osimertinib and LDE.
Findings:
- The patient was managed with diphenhydramine mouthwash and dietary modifications.
- Moderate symptom improvement was observed after four weeks.
Implications:
- Oral LDE is a premalignant condition requiring regular monitoring.
- Recognizing osimertinib-induced LDE can prevent misdiagnosis and ensure timely treatment.
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