Successful rechallenge with almonertinib and corticosteroids after gefitinib-induced interstitial lung disease: A case report and literature review.
Jie Liu, Tengchen Wei, Zhenming Bao et al.
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Case in brief
A 53-year-old never-smoking woman with stage IV, EGFR L858R-mutant lung adenocarcinoma developed progressive dyspnea and hypoxemia after two months of gefitinib, despite an initial tumor response. She was diagnosed with grade 3 gefitinib-associated interstitial lung disease (ILD); gefitinib was stopped and methylprednisolone given. After subsequent chemotherapy and later tumor progression, she received almonertinib with methylprednisolone. Tumor shrinkage followed, with no reported recurrence of pulmonary toxicity; at last follow-up, progression-free survival on almonertinib was approximately 8 months.
What made this case unusual
The report describes rechallenge with a third-generation EGFR inhibitor after resolution of severe ILD associated with gefitinib, alongside corticosteroid use, without reported recurrent pulmonary toxicity.
Diagnostic / clinical pearl
In this single case, severe gefitinib-associated ILD was followed by almonertinib rechallenge with methylprednisolone and close surveillance; the outcome supports feasibility in a selected patient, not established safety.
Why it matters
The report highlights the limited evidence on EGFR-TKI rechallenge after ILD and cautions that a favorable outcome in one patient cannot establish general safety.