Brief Report: Severe Pneumonitis After Combined Thoracic Radiotherapy and Osimertinib

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

JTO Clinical and Research Reports (Mar 2023)

Brief Report: Severe Pneumonitis After Combined Thoracic Radiotherapy and Osimertinib

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

Affiliations

Clayton P. Smith, MD: Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
Michael Xiang, MD, PhD: Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
Stephanie M. Yoon, MD: Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
Alan Lee, MD: Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
Dan Ruan, PhD: Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
Jonathan W. Goldman, MD: Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
Amy L. Cummings, MD: Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
Aaron Lisberg, MD: Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
Edward B. Garon, MD, MS: Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
Drew Moghanaki, MD, MPH: Department 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.

Journal volume & issue: Vol. 4, no. 3
p. 100468

Abstract

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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.

Published in JTO Clinical and Research Reports

ISSN: 2666-3643 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jto-clinical-and-research-reports/

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