A non-small cell lung cancer patient experiencing venous thromboembolism during Osimertinib treatment, with disease recurrence and progression after therapy: a case report and literature review

Abstract

Abstract Background:In advanced non-small cell lung cancer(NSCLC) with epidermal growth factor receptor (EGFR) gene mutations, the epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) have significantly improved patient prognosis. The third-generation EGFR-TKI, Osimertinib, has become the standard first-line treatment. In recent years, some studies have suggested that Osimertinib may carry a higher risk of developing venous thromboembolism (VTE) in the real world. There have been some related cases of Osimertinib inducing thrombus formation, although the underlying mechanisms remain unclear.As one of the most critical complications of cancer, the occurrence mechanisms and treatment strategies for venous thromboembolism (VTE) have been widely paid attention. Tumor promotes thrombus formation through various pathways, while the body's hypercoagulable state facilitates the growth, metastasis, and invasion of tumor cells, impacting the treatment process for cancer patients, prolonging hospitalization, and potentially leading to the death of patients. Case Description:We report a case of a NSCLC patient with exon 19 deletion mutation of EGFR gene who developed acute venous thromboembolism (VTE) during treatment with Osimertinib. After combined anticoagulant therapy, the patient showed improvement in the condition and resolution of the thrombus. However, upon discontinuation of anticoagulation and continued use of Osimertinib, there was recurrence of venous thromboembolism, increase in the size of the cancerous lesion, and eventual death. The patient had a progression-free survival(PFS) of 8 months after the onset of VTE and an overall survival(OS) of 10 months.To our knowledge, this is the first reported case of VTE recurrence in a patient continuing Osimertinib after receiving Osimertinib combined anticoagulant therapy. Conclusions:In this case, after taking osimertinib for half a month, the NSCLC patient developed acute venous thromboembolism, and then experienced resolution of the thrombus and reduction in cancer size with Osimertinib combined with anticoagulant therapy. Considering relevant literature, Osimertinib might contribute to and accelerate the occurrence of VTE in cancer patients. Combined anticoagulant therapy may assist in controlling both the cancerous lesion and thrombotic conditions, extending the progression-free survival. However, the recurrence and progression of the condition upon discontinuation of anticoagulation and continued Osimertinib use suggest an interrelation between tumor cell growth, metastasis, and thrombus formation, impacting the therapeutic outcomes for cancer patients and even leading to patient mortality.