Abstract
SummaryWe report a case of a 38-year-old woman who was diagnosed with stage IV lung adenocarcinoma, harboring an epidermal growth factor receptor (EGFR) L858R mutation on exon 21 and a T790 M mutation on exon 20. The patient was treated with osimertinib, a third-generation EGFR tyrosine kinase inhibitor (EGFR-TKI) following treatment with nivolumab, an anti-Programmed Cell Death 1 (anti-PD1) antibody. After initiating osimertinib treatment, the patient began to complain of low-grade fever and shortness of breath without hypoxemia, and her chest radiograph and a CT scan revealed a remarkable antitumor response, although faint infiltrations were observed in the bilateral lung field. Bronchoalveolar lavage fluid mainly contained lymphocytes (CD4+/CD8+ ratio of 0.3), and a transbronchial lung biopsy specimen showed lymphocytic alveolitis with partial organization in several alveolar spaces. Therefore we diagnosed the patient with osimertinib-induced interstitial lung disease (ILD) after treatment with anti-PD1 antibody. We considered anti-PD1 therapies may be the risk factor of EGFR-TKI-induced ILD.
Highlights
Thirty-one days after initiating osimertinib treatment, the patient began to complain of low-grade fever and shortness of breath without hypoxemia
General blood tests including serum inflammatory markers, white blood cell count, and CRP level were within the normal range, serum KL-6 was elevated from 547 U/mL (May 2016) to 2310 U/mL (June 2016). Based on these clinical findings, we diagnosed the patient with osimertinibinduced interstitial lung disease (ILD)
Two months after discontinuation of osimertinib treatment, a chest CT scan showed that the bilateral diffuse, faint, ground-glass opacities had disappeared completely, but right pleural thickening had worsened
Summary
Osimertinib-induced interstitial lung disease after treatment with anti-PD1 antibody. Received: 9 August 2016 / Accepted: 31 August 2016 / Published online: 6 September 2016 # The Author(s) 2016. This article is published with open access at Springerlink.com. The patient was treated with osimertinib, a third-generation EGFR tyrosine kinase inhibitor (EGFR-TKI) following treatment with nivolumab, an anti-Programmed Cell Death 1 (anti-PD1) antibody. The patient began to complain of low-grade fever and shortness of breath without hypoxemia, and her chest radiograph and a CT scan revealed a remarkable antitumor response, faint infiltrations were observed in the bilateral lung field. We diagnosed the patient with osimertinib-induced interstitial lung disease (ILD) after treatment with anti-PD1 antibody. We considered anti-PD1 therapies may be the risk factor of EGFR-TKI-induced ILD.
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