Re-administration of EGFR-TKI to mutated EGFR NSCLC patients after remission of osimertinib induced ILD

Abstract

Abstract Background Osimertinib is a key-drug to treat NSCLC harboring EGFR sensitizing mutation at 1st line setting as well as T790M resistant mutation at late line. Interstitial lung disease/pneumonitis (ILD) is a fatal adverse event induced by tyrosine kinase inhibitors including osimertinib especially in the Japanese patients. On the other hand, transient asymptomatic pulmonary opacities (TAPO) caused by osimertinib were reported as relatively frequent (10-20%) phenomenon and usually safe, permitting continuous or stop and go treatment with osimertinib. Purpose & Result We retrospectively analyzed consecutive 60 sonsequtive EGFR mutation positive NSCLC patients treated with osimertinib in our institution by Feb. 2019. Fifteen patients were TKI naive and the other 45 were pretreated with 1st or 2nd generation EGFR-TKI. ILD occurred in ten (16.7%) patients then administration of osimertinib was interrupted. Corticosteroid was administered to all patients for the ILD, resulting in fully remission of the lung adverse event without any related patient death. Three patients were re-administered with TKI (2 osimertinib for T790M positive, 1 gefitinib for 1st line setting) after remission of ILD. Re-challenged TKI was not successful for these patients resulting in ILD recurrence and permanent cease of TKI treatment. Conclusion We suggest that strategies other than re-administration of osimertinib should be considered even though osimertinib induced ILD is fully recovered by corticosteroid therapy.