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P3.CR - Case Reports (Not CME Accredited Session) (ID 984)
- Event: WCLC 2018
- Type: Poster Viewing in the Exhibit Hall
- Presentations: 1
- Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
P3.CR-14 - A Case of EGFR Tyrosine Kinase Inhibitor (TKI), Osimertinib Induced Pneumonitis in a Patient with Recurrent Fevers of Unknown Origin (ID 13731)
12:00 - 13:30 | Author(s): Danielle Cuthbert
64-year-old female with stage IV EGFR exon 19 mutated adenocarcinoma of lung on osimertinib presented with recurrent fevers of unknown origin.a9ded1e5ce5d75814730bb4caaf49419 Method
Section not aplicable.4c3880bb027f159e801041b1021e88e8 Result
Ms. M presented to the hospital with fevers. Osimertinib was held on admission. Imaging showed a possible pneumonia and she started IV antibiotics. Her fevers subsided and she was discharged on IV antibiotics. She resumed osimertinib upon discharge.
The following day, she spiked fevers to 103.9F. She was admitted to the hospital with fevers and new hypoxia requiring 4 liters of supplemental oxygen. Osimertinib was continued on admission.
The results of her infectious workup, including bronchoscopy studies, were negative and she continued to spike high fevers despite broadened coverage for atypicals and fungi. Osimertinib was stopped on hospital day #4 due to QTc prolongation likely from its interaction with other QT prolonging antimicrobials. Given persistently high fevers despite broad antibiotics and a negative infectious workup, Osimertinib-induced pneumonitis became a likely explanation. Anti-microbials were stopped and prednisone 1mg/kg daily was started. She deferversed and had a rapid symptomatic improvement.
Osimertinib toxicity has been investigated in the literature. In the AURA3 trial, pneumonitis resulted in 1/4 reported fatal adverse events. ILD–like events were reported in 10 patients (4%, 9 events were grade 1 or 2, 1 death). The FLUARA trial showed similar findings, with ILD-like adverse events in 11 patients (4%) with 7 “recovered” and 4 “recovering”. There were no reported fatal outcomes from ILD.
After stopping Osimertinib during her 2 hospitalizations, our patient defervesced after 4 days and 3 days, respectfully. This correlates with the 48-hour half-life of Osimertinib. Our case demonstrates that determining drug toxicity can be challenging, especially when other etiologies such as infection are more common. For Ms. M, her lack of improvement with anti-microbials coupled with a significant response to steroids makes the case for Osimertinib-induced pneumonitis.6f8b794f3246b0c1e1780bb4d4d5dc53
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