Scienze Radiologiche Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy.
Medical Oncology Unit, University Hospital of Parma, Parma, Italy.
Tumori. 2022 Dec;108(6):592-599. doi: 10.1177/03008916211047888. Epub 2021 Sep 29.
Osimertinib is a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) approved as first-line therapy for advanced -mutated non-small cell lung cancer (NSCLC). Some osimertinib-related interstitial lung diseases (ILDs) were shown to be transient, called transient asymptomatic pulmonary opacities (TAPO)-clinically benign pulmonary opacities that resolve despite continued osimertinib treatment-and are not associated with the clinical manifestations of typical TKI-associated ILDs.
In this multicentric study, we retrospectively analyzed 92 patients with -mutated NSCLC treated with osimertinib. Computed tomography (CT) examinations were reviewed by two radiologists and TAPO were classified according to radiologic pattern. We also analyzed associations between TAPO and patients' clinical variables and compared clinical outcomes (time to treatment failure and overall survival) for TAPO-positive and TAPO-negative groups.
TAPO were found in 18/92 patients (19.6%), with a median follow-up of 114 weeks. Median onset time was 16 weeks (range 6-80) and median duration time 14 weeks (range 8-37). The most common radiologic pattern was focal ground-glass opacity (54.5%). We did not find any individual clinical variable significantly associated with the onset of TAPO or significant difference in clinical outcomes between TAPO-positive and TAPO-negative groups.
TAPO are benign pulmonary findings observed in patients treated with osimertinib. TAPO variability in terms of CT features can hinder the differential diagnosis with either osimertinib-related mild ILD or tumor progression. However, because TAPO are asymptomatic, it could be reasonable to continue therapy and verify the resolution of the CT findings at follow-up in selected cases.
奥希替尼是一种第三代表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKI），被批准用于治疗晚期 - 突变型非小细胞肺癌（NSCLC）的一线治疗。一些奥希替尼相关的间质性肺病（ILDs）表现为短暂性，称为短暂无症状性肺混浊（TAPO）-临床良性肺混浊，尽管继续接受奥希替尼治疗，但会得到解决，并且与典型 TKI 相关的ILDs 的临床表现无关。
在这项多中心研究中，我们回顾性分析了 92 名接受奥希替尼治疗的 - 突变型 NSCLC 患者。由两名放射科医生对计算机断层扫描（CT）检查进行了审查，并根据放射学模式对 TAPO 进行了分类。我们还分析了 TAPO 与患者临床变量之间的关联，并比较了 TAPO 阳性和 TAPO 阴性组的临床结局（治疗失败时间和总生存期）。
在 92 名患者中发现了 18 例 TAPO（19.6%），中位随访时间为 114 周。中位发病时间为 16 周（范围 6-80），中位持续时间为 14 周（范围 8-37）。最常见的放射学模式是局灶性磨玻璃影（54.5%）。我们没有发现任何单个临床变量与 TAPO 的发病显著相关，也没有发现 TAPO 阳性和 TAPO 阴性组之间的临床结局有显著差异。
TAPO 是接受奥希替尼治疗的患者中观察到的良性肺部表现。TAPO 在 CT 特征方面的变异性可能会妨碍与奥希替尼相关的轻度ILD 或肿瘤进展的鉴别诊断。然而，由于 TAPO 是无症状的，在选定的情况下，继续治疗并在随访中验证 CT 发现的解决是合理的。
