Osimertinib-related Pulmonary Fibrosis, A case report and review of literature

Abstract

Abstract Lung cancers are the leading cause of mortality worldwide. Pulmonary malignancies are grossly divided into small-cell lung carcinoma and non-small-cell lung carcinoma. Non-small cell lung carcinoma contributes to the majority of tumor burden. The treatment regimen and subsequent prognosis for lung cancer depend on the type of cancer, the grade, and the stage. With the advancement in modern immunology and genetics, targeted treatment therapies targeted against specific genetic mutations and immune markers resulted in improved survival. Though these treatment modalities are considered to have minimal to no effect on co-existing normal tissues, there have been reports of side effects among patients on these advanced treatments. Here we present a case of 72 years old female with advanced metastatic non-small cell lung carcinoma who presented with significant deterioration of respiratory status. Initially, due to elevated inflammatory markers and fever, was treated with antibiotics. However, with worsening respiratory status despite being on appropriate antibiotics, she was started on steroids for the imaging findings suggestive of pulmonary fibrosis. Initiation of steroids resulted in rapid recovery, with the improvement of imaging findings and oxygen requirements. The patient was eventually discharged home without oxygen to follow up with hematology regarding further treatment. Osimertinib has been shown to improve progression-free survival compared to the earlier generations of EGFR TKIs, however, there are adverse effects to Osimertinib, with the most common being rash, diarrhea, and dry skin. More severe and potentially fatal, side effects like QT interval prolongation, interstitial lung disease, and drug-related pneumonitis are documented potential adverse effects as well. In all the reported cases, the removal of medication results in the improvement of pulmonary fibrosis. However, a few cases have reported successful reintroduction of Osimertinib once the fibrosis improves with no recurrence. There is a need to run blinded trials to find the association of Osimertinib with co-existent factors that can contribute to pulmonary fibrosis.