Pneumothorax in lung cancer following anlotinib treatment: A case report

Rationale: Anlotinib is an oral tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor, and has been approved for the treatment of patients with advanced nonsmall cell lung cancer who had received at least 2 previous chemotherapy and epidermal growth factor receptor/anaplastic lymphoma kinase targeted therapy regimens. Pneumothorax is a rare adverse reaction of this drug. Here, we present a case of pneumothorax following anlotinib treatment in a patient with lung cancer. Patient concerns: A 61-year-old Asian male long-term smoker was admitted to the hospital in November 2019 with sputum production and dyspnea. Diagnosis: The patient was diagnosed with right lung adenocarcinoma with mediastinal and rib metastases, combined with chronic obstructive pulmonary disease and pulmonary bullous disease. Interventions: The patient was treated with oral administration of anlotinib. The patient had a recurrent pneumothorax that improved after drug withdrawal and was free of recurrence. Therefore, pneumothorax caused by rupture of the pulmonary bullous due to anlotinib was considered. Outcomes: After discontinuing anlotinib, the patient has not developed pneumothorax to date. Lessons: Pneumothorax may occur when VEGF is inhibited, which can promote the proliferation and repair of alveolar wall substances, leading to alveolar rupture. With respect to pneumothorax, it is necessary to be aware of the risk of pulmonary bullous rupture during antitumor treatment with small-molecule tyrosine kinase drugs.