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A Case Report on the Development of Ulcerative Colitis During Osimertinib Therapy for Epidermal Growth Factor
Tomoki Tamura1, Misaki Tani1, Hiromichi Ogata1
1Department of Respiratory Medicine NHO Iwakuni Clinical Center Yamaguchi Japan.
Abstract:
Osimertinib, a standard treatment for epidermal growth factor receptor (EGFR)-positive non-small-cell lung cancer, commonly causes manageable diarrhoea. We report osimertinib-induced refractory diarrhoea diagnosed as ulcerative colitis, remitting with mesalazine. A 69-year-old woman with advanced-stage EGFR mutation-positive lung adenocarcinoma developed persistent diarrhoea 3 weeks after starting osimertinib, complicated by anorexia, hypotension, anaemia and renal failure requiring hospitalisation. While anaemia and renal failure improved after osimertinib cessation, diarrhoea persisted. A colonoscopy revealed ulcerative colitis, confirmed by neutrophil and lymphocyte infiltration in the intestinal mucosa, glandular deformation and decreased goblet cells. This case demonstrates that osimertinib-induced ulcerative colitis was successfully treated with mesalazine.
Insights
Osimertinib can cause severe diarrhea, sometimes diagnosed as ulcerative colitis. This case shows mesalazine effectively treated this condition in a patient with EGFR-positive lung cancer.
Area of Science:
- Oncology
- Gastroenterology
- Pharmacology
Background:
- Osimertinib is a standard targeted therapy for epidermal growth factor receptor (EGFR)-positive non-small-cell lung cancer (NSCLC).
- Diarrhea is a common side effect of osimertinib, usually manageable.
- Refractory diarrhea can significantly impact patient quality of life and treatment adherence.
Purpose of the Study:
- To report a rare case of osimertinib-induced ulcerative colitis.
- To highlight the diagnostic challenges and successful treatment of this adverse event.
Main Methods:
- A case report of a 69-year-old woman with advanced EGFR-positive lung adenocarcinoma.
- Clinical presentation, diagnostic workup including colonoscopy with biopsy, and treatment response were documented.
- Osimertinib was initiated, leading to severe gastrointestinal symptoms.
Main Results:
- The patient developed refractory diarrhea, anorexia, hypotension, anemia, and renal failure.
- Colonoscopy revealed findings consistent with ulcerative colitis.
- Diarrhea resolved with mesalazine treatment after discontinuation of osimertinib, with improvement in anemia and renal function.
Conclusions:
- Osimertinib can induce ulcerative colitis, presenting as refractory diarrhea.
- Mesalazine is an effective treatment for osimertinib-induced ulcerative colitis.
- Early recognition and appropriate management are crucial for patients experiencing severe gastrointestinal side effects during osimertinib therapy.
