Abstract
Background:
Rechallenge with EGFR tyrosine kinase inhibitors (TKIs) can be successful as a result of different TKI adverse event profiles. Grade 3 stomatitis seriously affects a patient’s life and leads to drug discontinuation, which can affect survival. Serious adverse effects caused by EGFR-TKIs, such as interstitial lung disease (ILD), can be fatal. This study provides new treatment options for patients who develop grade 3 stomatitis or ILD following EGFR-TKI therapy.
Case Description:
We present the case of a 67-year-old female patient with stage IV adenocarcinoma involving an EGFR exon 19 deletion mutation who received gefitinib for three months and then discontinued treatment due to grade 3 stomatitis. Icotinib was readministered without any adverse events (AEs). After stable control for 14 months, new liver metastases appeared, and three cycles of pemetrexed and carboplatin plus bevacizumab were administered. Subsequent next-generation sequencing of plasma indicated an EGFR T790M mutation, and the patient subsequently received osimertinib for three months. However, as the patient developed osimertinib-induced grade 3 ILD, the TKIs were discontinued, and high-dose methylprednisolone was administered. After symptomatic remission, half-dose aumolertinib and steroid protection were administered. As there was no ILD recurrence, aumolertinib was increased to the standard dose in 1 month, and the tumor achieved a partial response (PR) .The progression-free survival (PFS) with aumolertinib was more than 17 months without obvious AEs.
Conclusions:
We report a case of successful rechallenge with two different EGFR-TKIs. Faced with serious adverse effects such as ILD, the rechallenge can be attempted after a thorough assessment of clinical benefits and potential risks.