A case of EGFR mutation–positive lung adenocarcinoma treated with erlotinib plus ramucirumab after severe lung injury with osimertinib

Abstract

A female patient in her 60s was diagnosed with lung adenocarcinoma harboring an EGFR/exon 19 deletion mutation (cT1cN2bM1a(PLE), cStage IVA). Osimertinib was initiated but had to be discontinued after three months because of the development of grade 4 lung injury (Common Terminology Criteria for Adverse Events, Version 5.0), necessitating steroid therapy. One month after drug withdrawal, erlotinib combined with ramucirumab was commenced. During the subsequent eight months, no recurrence of lung injury was observed. Tyrosine kinase inhibitors play a crucial role in the management of EGFR mutation–positive lung cancer, and we explored the potential for reintroducing tyrosine kinase inhibitors following osimertinib-induced lung injury.