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Successful Erlotinib Rechallenge in a Non-small Cell Lung Cancer Patient With Erlotinib-Induced Interstitial Lung Disease (ILD) FREE TO VIEW

Xun Wang*, MD; Hongqing Zhao, MD
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Wuxi No. 2 People's Hospital, Nanjing Medical University, Wuxi, China

Chest. 2012;142(4_MeetingAbstracts):654A. doi:10.1378/chest.1390853
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SESSION TYPE: Cancer Student/Resident Cases

PRESENTED ON: Monday, October 22, 2012 at 01:45 PM - 03:00 PM

INTRODUCTION: The worldwide incidence of erlotinib-induced ILD is about 1%.Thus far, only 20 cases have been described, and erlotinib-induced ILD is fatal in approximately half of cases.

CASE PRESENTATION: A 57-year-old nonsmoking Chinese woman who complained of non-productive cough was diagnosed with non-small cell lung cancer stage IV (T4N3M1) in August 2011. Computed tomography (CT) scan showed a dominant right lung mass (Figure 1A) with pulmonary and bone metastases. She received pemetrexed plus cisplatin first-line chemotherapy for 2 courses,Because of radiological evaluation showed stable disease (SD) and an epithelial growth factor receptor (EGFR) exon 19 mutation was detected, She was started on treatment with erlotinib at the dose of 150 mg daily, as the second line chemotherapy, in October 2011. 52 days after the start of erlotinib, a follow-up chest CT showed inferior lobe of right lung diffuse ground-glass infiltrates (Figure 1B), the patient did not have any symptoms. We considered these lesions to be consistent with erlotinib-related ILD. Erlotinib therapy was stopped and prednisone treatment (30 mg/day of oral prednisone) was started immediately. On day 69,follow-up chest CT showed resolution of ground-glass lesions, but radiological evaluation showed progressive disease (PD). Erlotinib (75 mg/day) was prescribed with oral prednisolone (20 mg/day) on day 69. The patient achieved a partial response after treatment of erlotinib (Figure 1C).The prednisone dose was tapered over 4 months without recurrence of erlotinib-induced ILD. The patient is still alive.

DISCUSSION: In this case, we used erlotinib rechallenge with concurrent steroid therapy in a patient with active EGFR mutation after erlotinib-induced ILD. Further studies are needed to elucidate the mechanism of EGFR-TKI-induced ILD.

CONCLUSIONS: A reduced dose of erlotinib with concurrent steroid therapy seems to be a potential therapeutic option for the patients with EGFR mutations who develop erlotinib-induced ILD.

1) Dallas J, Jantz M, Lightsey J, Sonntag C, Kaye FJ. Successful erlotinib re-challenge after erlotinib-induced interstitial lung disease. J Thorac Oncol 2011;6:1142-3.

2) ter Heine R, van den Bosch RT, Schaefer-Prokop CM,et al, Fatal interstitial lung disease associated with high erlotinib and metabolite levels. A case report and a review of the literature. Lung Cancer,2012,75:391-7

3) Fukui T, Otani S, Hataishi R, et al. Successful rechallenge with erlotinib in a patient with EGFR mutant lung adenocarcinoma who developed gefitinib-related interstitial lung disease. Cancer Chemother Pharmacol 2010;65:803-6.

DISCLOSURE: The following authors have nothing to disclose: Xun Wang, Hongqing Zhao

No Product/Research Disclosure Information

Wuxi No. 2 People's Hospital, Nanjing Medical University, Wuxi, China




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