Osimertinib
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Interstitial lung disease: 6 case reports In a retrospective study of 42 patients conducted between August 2018 and September 2019, 6 patients (2 men and 4 women) aged 41–83 years were described, who developed interstitial lung disease (ILD) during treatment with osimertinib for non-small-cell lung cancer (NSCLC) [route not stated; not all dosages stated]. Case 1: A 69-year-old man, who was diagnosed with NSCLC, started receiving osimertinib 80 mg/day. On day 65 of osimertinib therapy, his ALT and AST levels increased. Lab tests showed KL-6 394 U/mL, CRP 0.02 mg/dL and LDH 135 U/L. Hence, osimertinib was suspended. Thereafter, osimertinib 40 mg/day was resumed on day 106. On day 155, a chest CT scan showed slight groundglass opacities in lower lobes of both lungs, and grade 1 ILD was suspected. Therefore, osimertinib therapy was discontinued, and the ILD resolved without intervention. Meanwhile, he had increase in the cancer lesions. Hence, afatinib was initiated and no recurrence of the lung disease noted. Case 2: A 77-year-old woman, who was diagnosed with NSCLC, started receiving osimertinib 80 mg/day. On day 43 of osimertinib therapy, she presented to the hospital due to dyspnoea on exertion and fever. A chest CT scan showed slight groundglass opacities in her lower lobes of both lungs and grade 2 ILD was suspected. Lab tests showed KL-6 400 U/mL, CRP 0.7 mg/dL and LDH 261 U/L. Hence, osimertinib was suspended. One month after the discontinuation of osimertinib, her lung disease resolved. She then received 4 courses of carboplatin and pemetrexed therapy. However, her lung cancer progressed. Subsequently, treatment with afatinib was started. Nine months after initiation of afatinib, no recurrence of interstitial lung disease was observed, and she achieved a partial response. Case 3: An 81-year-old woman, who was diagnosed with NSCLC, started receiving osimertinib 80 mg/day. On day 51 of osimertinib therapy, she was admitted due to dyspnoea and fever. A chest CT scan showed diffused ground-glass opacities and infiltration in her lungs. Grade 3 ILD was suspected. Lab tests showed KL-6 509 U/mL, CRP 2.43 mg/dL and LDH 281 U/L. She also developed respiratory failure. Hence, corticosteroid therapy was started that led to improvement in her imaging signs. Eventually, corticosteroid was stopped and afatinib was started. Nine months after initiation of afatinib, no recurrence of interstitial lung disease was observed and she attended stable disease. Case 4: A 41-year-old woman, who was diagnosed with NSCLC, started receiving osimertinib 80 mg/day. On day 23 of osimertinib therapy, a chest CT scan showed slight ground-glass opacities in her the right lower lobe of lung were noted. Lab tests showed KL-6 172 U/mL, CRP 0.5 mg/dL and LDH 206 U/L. She had no symptoms. Grade 1 ILD was suspected, and osimertinib was stopped. A spontaneous resolution of the ILD was noted. Subsequently, she received afatinib and a partial response was achieved. Five months after initiation of afatinib, no recurrence of interstitial lung dise
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