Brief Report: Severe Pneumonitis After Combined Thoracic Radiotherapy and Osimertinib
Introduction: Osimertinib is an effective treatment for metastatic NSCLC. Occasionally, thoracic radiation therapy (TRT) is delivered to patients receiving osimertinib to treat residual or progressing pulmonary tumors. Anecdotal reports suggest that the delivery of TRT in combination with osimertini...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | JTO Clinical and Research Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666364323000073 |
| _version_ | 1797855284293533696 |
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| author | Clayton P. Smith, MD Michael Xiang, MD, PhD Stephanie M. Yoon, MD Alan Lee, MD Dan Ruan, PhD Jonathan W. Goldman, MD Amy L. Cummings, MD Aaron Lisberg, MD Edward B. Garon, MD, MS Drew Moghanaki, MD, MPH |
| author_facet | Clayton P. Smith, MD Michael Xiang, MD, PhD Stephanie M. Yoon, MD Alan Lee, MD Dan Ruan, PhD Jonathan W. Goldman, MD Amy L. Cummings, MD Aaron Lisberg, MD Edward B. Garon, MD, MS Drew Moghanaki, MD, MPH |
| author_sort | Clayton P. Smith, MD |
| collection | DOAJ |
| description | Introduction: Osimertinib is an effective treatment for metastatic NSCLC. Occasionally, thoracic radiation therapy (TRT) is delivered to patients receiving osimertinib to treat residual or progressing pulmonary tumors. Anecdotal reports suggest that the delivery of TRT in combination with osimertinib may be associated with a high risk of severe pneumonitis. Methods: A retrospective study was performed at a single academic medical center in the United States to investigate the incidence of severe pneumonitis among patients treated with combined TRT and osimertinib between June 2016 and December 2021. Baseline patient characteristics, tumor size and location, and dosimetric parameters were evaluated. The highest grade of radiation pneumonitis that developed within 6 months of treatment was scored in accordance with the Common Terminology Criteria for Adverse Events version 5.0. Results: A total of 16 patients were identified who were treated with combined TRT and osimertinib. All had a diagnosis of metastatic NSCLC. Treatment-related grade greater than or equal to 2 pneumonitis developed in 56%, grade greater than or equal to 3 in 37.5%, and grade 4 in 6.3%; no patient developed grade 5 pneumonitis. Median time to any-grade pneumonitis was 29 days (1–84 d); all patients had symptom resolution with expectant management or oral steroid therapies. All patients discovered to have grade greater than or equal to 3 pneumonitis (n = 6) received TRT to tumors located within 2 cm of the proximal bronchial tree, including tumors abutting the proximal bronchial tree (n = 2) and within the mediastinum (n = 1). Conclusions: The combination of TRT with osimertinib was associated with a high rate of severe pneumonitis that required oral steroid medications. Larger studies are needed to validate these findings and to understand the clinical and treatment factors that influence this risk and how they can be mitigated. |
| first_indexed | 2024-04-09T20:20:05Z |
| format | Article |
| id | doaj.art-b2b61572fb9f435fa78b46c90498509e |
| institution | Directory Open Access Journal |
| issn | 2666-3643 |
| language | English |
| last_indexed | 2024-04-09T20:20:05Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTO Clinical and Research Reports |
| spelling | doaj.art-b2b61572fb9f435fa78b46c90498509e2023-03-31T05:55:32ZengElsevierJTO Clinical and Research Reports2666-36432023-03-0143100468Brief Report: Severe Pneumonitis After Combined Thoracic Radiotherapy and OsimertinibClayton P. Smith, MD0Michael Xiang, MD, PhD1Stephanie M. Yoon, MD2Alan Lee, MD3Dan Ruan, PhD4Jonathan W. Goldman, MD5Amy L. Cummings, MD6Aaron Lisberg, MD7Edward B. Garon, MD, MS8Drew Moghanaki, MD, MPH9Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CaliforniaDepartment of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CaliforniaDepartment of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CaliforniaDepartment of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CaliforniaDepartment of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CaliforniaDivision of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CaliforniaDivision of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CaliforniaDivision of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CaliforniaDivision of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CaliforniaDepartment of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; Corresponding author. Address for correspondence: Drew Moghanaki, MD, MPH, Department of Radiation Oncology, David Geffen School of Medicine, University of California Los Angeles, 200 Medical Plaza Driveway, Suite #B265, Los Angeles, CA 90095-6951.Introduction: Osimertinib is an effective treatment for metastatic NSCLC. Occasionally, thoracic radiation therapy (TRT) is delivered to patients receiving osimertinib to treat residual or progressing pulmonary tumors. Anecdotal reports suggest that the delivery of TRT in combination with osimertinib may be associated with a high risk of severe pneumonitis. Methods: A retrospective study was performed at a single academic medical center in the United States to investigate the incidence of severe pneumonitis among patients treated with combined TRT and osimertinib between June 2016 and December 2021. Baseline patient characteristics, tumor size and location, and dosimetric parameters were evaluated. The highest grade of radiation pneumonitis that developed within 6 months of treatment was scored in accordance with the Common Terminology Criteria for Adverse Events version 5.0. Results: A total of 16 patients were identified who were treated with combined TRT and osimertinib. All had a diagnosis of metastatic NSCLC. Treatment-related grade greater than or equal to 2 pneumonitis developed in 56%, grade greater than or equal to 3 in 37.5%, and grade 4 in 6.3%; no patient developed grade 5 pneumonitis. Median time to any-grade pneumonitis was 29 days (1–84 d); all patients had symptom resolution with expectant management or oral steroid therapies. All patients discovered to have grade greater than or equal to 3 pneumonitis (n = 6) received TRT to tumors located within 2 cm of the proximal bronchial tree, including tumors abutting the proximal bronchial tree (n = 2) and within the mediastinum (n = 1). Conclusions: The combination of TRT with osimertinib was associated with a high rate of severe pneumonitis that required oral steroid medications. Larger studies are needed to validate these findings and to understand the clinical and treatment factors that influence this risk and how they can be mitigated.http://www.sciencedirect.com/science/article/pii/S2666364323000073PneumonitisRadiation therapyOsimertinibEGFR-mutated NSCLC |
| spellingShingle | Clayton P. Smith, MD Michael Xiang, MD, PhD Stephanie M. Yoon, MD Alan Lee, MD Dan Ruan, PhD Jonathan W. Goldman, MD Amy L. Cummings, MD Aaron Lisberg, MD Edward B. Garon, MD, MS Drew Moghanaki, MD, MPH Brief Report: Severe Pneumonitis After Combined Thoracic Radiotherapy and Osimertinib JTO Clinical and Research Reports Pneumonitis Radiation therapy Osimertinib EGFR-mutated NSCLC |
| title | Brief Report: Severe Pneumonitis After Combined Thoracic Radiotherapy and Osimertinib |
| title_full | Brief Report: Severe Pneumonitis After Combined Thoracic Radiotherapy and Osimertinib |
| title_fullStr | Brief Report: Severe Pneumonitis After Combined Thoracic Radiotherapy and Osimertinib |
| title_full_unstemmed | Brief Report: Severe Pneumonitis After Combined Thoracic Radiotherapy and Osimertinib |
| title_short | Brief Report: Severe Pneumonitis After Combined Thoracic Radiotherapy and Osimertinib |
| title_sort | brief report severe pneumonitis after combined thoracic radiotherapy and osimertinib |
| topic | Pneumonitis Radiation therapy Osimertinib EGFR-mutated NSCLC |
| url | http://www.sciencedirect.com/science/article/pii/S2666364323000073 |
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