EGFR-Mutant Stage IV Lung Cancer Treated After Osimertinib-Related Lung Toxicity
This lung cancer diagnosis at a glance
- Stage at diagnosis
- Stage IV
- Subtype
- Adenocarcinoma
- Biomarkers
- EGFR exon 19 deletion; later EGFR T790M resistance mutation
- Sex
- female
- Spread to
- brain, lungs, bones, left adrenal gland, meninges
- Treatment
- targeted therapy and radiation
- Outcome
- Responding Well
Treatment course, step by step
- Started osimertinib for EGFR-mutant Stage IV lung adenocarcinoma.
- Osimertinib was stopped after 42 days because of drug-induced interstitial lung disease, which improved with corticosteroids.
- Switched to afatinib and achieved a partial response before new lung metastases appeared 18 months later.
- Received whole-brain radiation when brain metastases later worsened.
- After meningeal spread and detection of an EGFR T790M mutation, restarted lower-dose osimertinib with corticosteroids and again achieved tumor shrinkage without recurrent interstitial lung disease.
What happened, in summary
A 67-year-old woman was diagnosed with Stage IV lung adenocarcinoma involving the brain, lungs, bones, and left adrenal gland. Testing found an EGFR exon 19 deletion, and she began osimertinib as first-line targeted therapy.
After 42 days, she developed shortness of breath and was diagnosed with osimertinib-related interstitial lung disease. Osimertinib was stopped and corticosteroids rapidly improved the lung inflammation. She declined cytotoxic chemotherapy and instead switched to afatinib, achieving a partial response without another episode of interstitial lung disease.
Eighteen months later, new lung metastases appeared. She continued afatinib, but worsening brain metastases eventually required whole-brain radiation. The cancer later spread to the meninges, and a blood test detected an acquired EGFR T790M resistance mutation. With limited alternatives, she and her family chose to retry osimertinib at a lower dose together with corticosteroids. The rechallenge reduced the tumor and did not trigger another episode of interstitial lung disease in the latest documented follow-up.
Where this story comes from
This is a lay summary of an account first published by PMC / PubMed Central. Read the original in full
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Collections this story belongs to
- Stage 4 Lung Cancer 384 stories
- Stage 4 EGFR Mutation Lung Cancer 74 stories
- EGFR Mutation Lung Cancer 112 stories
- Afatinib for Lung Cancer 37 stories
These are lay summaries of published cancer stories, for information only. No two cancers behave the same way, and nothing here predicts your own diagnosis or replaces advice from your oncology team. Read the full disclaimer