Clinical Characteristics Of Osimertinib-Associated Interstitial Pneumonia And Literature Review(Report Of 1 Case)

Objective:To explore the clinical characteristics,diagnosis and treatment of ohitinib associated interstitial pneumonia,summarize the diagnosis and treatment experience and clinical characteristics of ohitinib associated interstitial pneumonia,improve the understanding level of osmertinib(TAGRISSO/AZD9291)associated interstitial pneumonia,and reduce missed diagnosis and misdiagnosis.Methods: Retrospective analysis was made on the clinical manifestations,laboratory examinations,imaging and pathological data,diagnosis and treatment process of a patient with oxitinib associated pneumonia in our hospital,and review the relevant literature to discuss the clinical characteristics,related factors,and main points of diagnosis and treatment of interstitial pneumonia(IP)caused by osmertinib.Results :(1)Case analysis results: The patient was a 66-year-old male with a long history of smoking and good health.The main symptoms were cough and shortness of breath.CT showed "mass in the anterior basal segment of the right lower lobe".Lung adenocarcinoma was pathologically diagnosed by percutaneous lung biopsy,and EGFR19 del was detected by pathological genetic examination.He was admitted to hospital and diagnosed as "right lung adenocarcinoma(c T4N3M1 c stage ⅳB,EGFR19del)".Osimertinib was given at a dose of 80 mgqd,and osimertinib-related interstitial pneumonia developed about 60 days after treatment,which was discontinued and treated with glucocorticoids,and improved after1 month of treatment.Two weeks later,the interstitial pneumonia recurred.The drug and hormone therapy were stopped again,and then the treatment was transferred to chemotherapy.No interstitial pneumonia recurred at the last follow-up in July 2022.(2)Literature review results: Case reports on osimertinib-induced interstitial pneumonia from November 2015 to April 2022 were retrieved from relevant databases,and a total of 15 literatures were selected,including 14 English literatures and 1 Chinese literature.There was no difference in the incidence between males and females.The average age was 68 years old,2 cases had smoking history,and 11 cases had no smoking history.Most of the pathological types were adenocarcinoma.All the 15 patients included in the statistics were given osimertinib according to the instructions,and all of them had dyspnea of varying degrees after the onset of IP.The onset time was mostly within 1 week to 3 months after the administration of IP(11cases,73.3%).The grade of adverse reactions was mostly 2-3,but 2 patients died.Treatment methods include discontinuation of osimertinib,use of glucocorticoid anti-inflammatory and oxygen therapy.Most patients can relieve symptoms after treatment,and most patients can be challenged to use osimertinib after IP improvement.Conclusion:1.Interstitial pulmonary disease is a rare but fatal serious adverse reaction caused by osimertinib.2.The key to prevent osimertinib related interstitial pneumonia is to conduct strict pharmaceutical evaluation on the patients before using the drug,closely observe the respiratory symptoms of the patients during the use of the drug,and achieve timely diagnosis and early treatment.3.The key to successful treatment of interstitial pneumonia caused by osimertinib is to immediately stop using osimertinib and give timely and sufficient glucocorticoid and oxygen therapy.Patients with contraindications to the use of hormones can consider using Nidanib.4.At present,it is not clear whether the interstitial pneumonia caused by osimertinib is induced by direct toxicity or dose dependent toxicity.However,by reducing the daily dose,starting the challenge of osimertinib treatment,and at the same time giving glucocorticoid maintenance treatment,it seems to reduce the risk of recurrence of IP in patients.