Osimertinib-induced interstitial lung disease after treatment with anti-PD1 antibody.
We 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.
Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
Nobuaki
N
Mamesaya
Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan. h.kenmotsu@scchr.jp.
Hirotsugu
H
Kenmotsu
Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Shizuoka, Japan.
Mineo
M
Katsumata
Division of Pathology, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
Takashi
T
Nakajima
Division of Diagnostic Radiology, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
Masahiro
M
Endo
Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
Toshiaki
T
Takahashi
D000178:Acrylamides; D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000814:Aniline Compounds; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy; D000077594:Nivolumab; D010879:Piperazines / Q000009:adverse effects*; D061026:Programmed Cell Death 1 Receptor / Q000276:immunology; D047428:Protein Kinase Inhibitors / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D007211:Indoles; D011743:Pyrimidines
D000178:Acrylamides; D000814:Aniline Compounds; D000911:Antibodies, Monoclonal; D000970:Antineoplastic Agents; D000077594:Nivolumab; D010879:Piperazines; D061026:Programmed Cell Death 1 Receptor; D047428:Protein Kinase Inhibitors; C105992:PDCD1 protein, human; C000596361:osimertinib; D007211:Indoles; D011743:Pyrimidines
Anti-PD1 antibody; EGFR mutation; EGFR tyrosine kinase inhibitor; Interstitial lung disease; Lung cancer