医学
奥西默替尼
肺癌
不良事件通用术语标准
内科学
肺炎
间质性肺病
过敏性肺炎
危险系数
肿瘤科
支气管肺泡灌洗
表皮生长因子受体
肺炎
胃肠病学
病理
肺
癌症
埃罗替尼
置信区间
作者
Yuki Sato,Hiromitsu Sumikawa,Ryota Shibaki,Takeshi Morimoto,Yoshihiko Sakata,Yuko Oya,Motohiro Tamiya,Hidekazu Suzuki,Hirotaka Matsumoto,Takashi Yokoi,Kazuki Hashimoto,Hiroshi Kobe,Aoi Hino,Megumi Inaba,Yoko Tsukita,Hideki Ikeda,Daisuke Arai,Hirotaka Maruyama,Satoshi Hara,Shinsuke Tsumura,Shinya Sakata,Daichi Fujimoto
出处
期刊:Chest
[Elsevier]
日期:2022-11-01
卷期号:162 (5): 1188-1198
被引量:16
标识
DOI:10.1016/j.chest.2022.05.035
摘要
Osimertinib has demonstrated impressive efficacy as a first-line treatment for patients with advanced epidermal growth factor receptor (EGFR) mutation-positive (m+) lung cancer. Drug-related pneumonitis (DRP) is a potentially lethal complication of osimertinib treatment, but reliable real-world data currently are lacking.What is the prevalence of osimertinib-induced DRP in first-line settings? What are the characteristics, clinical impact, and risk factors of osimertinib-induced DRP?We conducted a retrospective multicenter cohort study of patients who received osimertinib as a first-line treatment for advanced EGFR m+ non-small cell lung cancer (NSCLC) between August 2018 and December 2019. All chest CT scans and clinical information during osimertinib exposure were collected until June 2020. The primary end point was DRP incidence identified through central review.A total of 452 patients from 18 institutions were evaluated. Eighty patients (18%) had a diagnosis of DRP (all grades), and 21 patients (4.6%) had a diagnosis of grade 3 or more DRP. Among the patients with DRP, 46% were identified as having transient asymptomatic pulmonary opacity (TAPO). Regarding the CT scan patterns, organizing pneumonia, simple pulmonary eosinophilia, hypersensitivity pneumonia, diffuse alveolar damage, and nonspecific interstitial pneumonia were found in 30, 21, 18, 9, and two patients (38%, 26%, 23%, 11%, and 3%), respectively. In multivariate analysis, smoking history was identified as an independent risk factor for DRP (hazard ratio, 1.72; 95% CI, 1.01-2.89; P = .046). In the 3-month landmark analysis, DRP was associated with poor treatment efficacy; however, the presence of TAPO did not affect treatment efficacy negatively.For osimertinib treatment in first-line settings, the frequency of DRP was considerably elevated to 18 %, and half of these patients exhibited TAPO features.