Shoji Satoshi, Watanabe Satoshi, Hanazawa Yusuke, Fujisaki Toshiya, Kikuchi Toshiaki
Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Department of Respiratory Medicine, Joetsu General Hospital, Joetsu, Japan.
Transl Lung Cancer Res. 2022 Dec;11(12):2601-2607. doi: 10.21037/tlcr-22-419.
Previous phase III study has demonstrated that osimertinib, a third-generation epidermal growth factor receptor (EGFR)-tyrosine-kinase inhibitor (TKI), exhibits superior antitumor effects compared to first-generation EGFR-TKIs and successfully prolonged overall survival (OS) in patients with -mutated non-small cell lung cancer (NSCLC). Although first- and second-generation EGFR-TKIs are risk factors for venous thromboembolism (VTE), whether osimertinib increases the VTE risk remains unclear. In addition, no treatment strategy exists for patients with VTE during osimertinib. Here we present the clinical course of three patients with suspected osimertinib-induced VTE who were successfully treated with direct oral anticoagulation without recurrence VTE during osimertinib therapy.
Three male patients, aged 66-74 years, with NSCLC harboring mutations had been treated with osimertinib as the first- and second-line treatments, and developed VTE. All patients responded to osimertinib, and none showed disease progression at VTE onset. All patients were treated with direct oral anticoagulation and could resume osimertinib treatment. The progression-free survival (PFS) from VTE onset in each of the three cases was 11.4+, 7.7, and 6.1 months, respectively. The OS from VTE onset was 11.4+, 26.0, and 25.9+ months, respectively.
We report the cases of three NSCLC patients who developed VTE during osimertinib. Osimertinib may cause VTE and should be used cautiously. In such cases, osimertinib treatment may be continued with direct oral anticoagulation therapy.
先前的III期研究表明，第三代表皮生长因子受体（EGFR）-酪氨酸激酶抑制剂（TKI）奥希替尼与第一代EGFR-TKI相比，具有更优的抗肿瘤效果，并成功延长了EGFR突变的非小细胞肺癌（NSCLC）患者的总生存期（OS）。虽然第一代和第二代EGFR-TKI是静脉血栓栓塞（VTE）的危险因素，但奥希替尼是否会增加VTE风险仍不清楚。此外，对于接受奥希替尼治疗期间发生VTE的患者，尚无治疗策略。在此，我们报告3例疑似奥希替尼诱发VTE的患者的临床病程，他们在接受直接口服抗凝治疗后成功治愈，且在奥希替尼治疗期间未再发生VTE。
3例男性患者，年龄66 - 74岁，患有EGFR突变的NSCLC，接受奥希替尼作为一线和二线治疗，并发生了VTE。所有患者对奥希替尼均有反应，且在VTE发作时均未出现疾病进展。所有患者均接受直接口服抗凝治疗，并可恢复奥希替尼治疗。3例患者从VTE发作开始的无进展生存期（PFS）分别为11.4 +、7.7和6.1个月。从VTE发作开始的总生存期（OS）分别为11.4 +、26.0和25.9 +个月。
我们报告了3例NSCLC患者在接受奥希替尼治疗期间发生VTE 的病例。奥希替尼可能会导致VTE，应谨慎使用。在这种情况下，可继续使用奥希替尼治疗并联合直接口服抗凝治疗。
