Sato Yozo, Sekine Akimasa, Hagiwara Eri, Sato Midori, Yamaya Takafumi, Asaoka Masato, Higa Katsuyuki, Ikeda Satoshi, Baba Tomohisa, Komatsu Shigeru, Iwasawa Tae, Ogura Takashi
Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan.
Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Japan.
Respir Med Case Rep. 2021 Jun 23;33:101450. doi: 10.1016/j.rmcr.2021.101450. eCollection 2021.
Herein, we report the case of an 84-year-old woman with epidermal growth factor receptor () mutation exon 19 deletion postoperative recurrent lung adenocarcinoma. Osimertinib was administered as a first-line treatment; however, she was urgently admitted to our hospital due to dyspnea on the 46th day. Chest computed tomography revealed bilateral diffuse ground-glass opacities (GGOs) suggestive of grade 3 osimertinib-induced interstitial lung disease (ILD). After discontinuation of osimertinib in combination with short-term corticosteroid therapy, widespread GGOs were promptly resolved. As the disease gradually deteriorated after discontinuation of osimertinib, we administered osimertinib (80 mg every other day) followed by careful observation. However, bilateral GGOs re-appeared on the 15th day, and the diagnosis of osimertinib-induced ILD was established. After the improvement in ILD following corticosteroid therapy, afatinib was administered as salvage therapy, resulting in desirable control of lung cancer without any relapse of ILD. Our results indicate that afatinib would be a promising alternative treatment option even in patients who develop osimertinib-induced ILD and experience failure of osimertinib rechallenge.
在此，我们报告一例84岁女性患者，她患有表皮生长因子受体（EGFR）外显子19缺失的术后复发性肺腺癌。奥希替尼作为一线治疗药物；然而，在第46天时，她因呼吸困难紧急入住我院。胸部计算机断层扫描显示双侧弥漫性磨玻璃影（GGOs），提示3级奥希替尼诱导的间质性肺疾病（ILD）。在停用奥希替尼并联合短期皮质类固醇治疗后，广泛的GGOs迅速消退。由于停用奥希替尼后病情逐渐恶化，我们给予奥希替尼（每隔一天80mg）并密切观察。然而，双侧GGOs在第15天再次出现，奥希替尼诱导的ILD诊断成立。在皮质类固醇治疗后ILD有所改善后，给予阿法替尼作为挽救治疗，肺癌得到了理想的控制，ILD未再次复发。我们的结果表明，即使在出现奥希替尼诱导的ILD且奥希替尼再挑战失败的患者中，阿法替尼也将是一种有前景的替代治疗选择。
