{"title":"Two instances of successful oral desensitisation following hypersensitivity reaction in a patient receiving osimertinib: a case report","authors":"Georgia D. Bennett BPharm, Krysti Rosmalen-Brinkley MBBS, Kristoffer Johnstone BPharm, Genevieve Messina BPharm","doi":"10.1002/jppr.1928","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Osimertinib is an irreversible epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitor (TKI) and an available therapy for patients with non-small cell lung cancer (NSCLC) that have an EGFR or T790M mutation. It has become the preferred TKI in this patient group as it is superior to first-generation TKIs; however, osimertinib may be discontinued due to various toxicities or reactions.</p>\n </section>\n \n <section>\n \n <h3> Aim</h3>\n \n <p>We report two instances of successful osimertinib desensitisation in a 70-year-old woman requiring treatment for NSCLC following two hypersensitivity reactions presenting as angioedema and urticaria.</p>\n </section>\n \n <section>\n \n <h3> Clinical details</h3>\n \n <p>Osimertinib desensitisation started at 5 mg/day and was gradually increased to 80 mg/day over a period of 30 days.</p>\n </section>\n \n <section>\n \n <h3> Outcomes</h3>\n \n <p>The patient continued osimertinib 80 mg daily for over a year until treatment was withheld for 4 weeks due to thrombocytopenia and diverticulitis. She restarted osimertinib, completing a second desensitisation to a reduced dose of 40 mg daily without serious adverse effect. The patient continues reduced-dose osimertinib with stable disease.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>This case report proposes an osimertinib desensitisation strategy useful for select patients experiencing osimertinib-induced hypersensitivity reactions. It also demonstrates that if there is prolonged disruption to treatment, a second desensitisation can be completed successfully in the same patient so effective treatment in NSCLC may be continued.</p>\n </section>\n </div>","PeriodicalId":16795,"journal":{"name":"Journal of Pharmacy Practice and Research","volume":"54 4","pages":"328-332"},"PeriodicalIF":1.0000,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jppr.1928","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pharmacy Practice and Research","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jppr.1928","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Osimertinib is an irreversible epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitor (TKI) and an available therapy for patients with non-small cell lung cancer (NSCLC) that have an EGFR or T790M mutation. It has become the preferred TKI in this patient group as it is superior to first-generation TKIs; however, osimertinib may be discontinued due to various toxicities or reactions.
Aim
We report two instances of successful osimertinib desensitisation in a 70-year-old woman requiring treatment for NSCLC following two hypersensitivity reactions presenting as angioedema and urticaria.
Clinical details
Osimertinib desensitisation started at 5 mg/day and was gradually increased to 80 mg/day over a period of 30 days.
Outcomes
The patient continued osimertinib 80 mg daily for over a year until treatment was withheld for 4 weeks due to thrombocytopenia and diverticulitis. She restarted osimertinib, completing a second desensitisation to a reduced dose of 40 mg daily without serious adverse effect. The patient continues reduced-dose osimertinib with stable disease.
Conclusion
This case report proposes an osimertinib desensitisation strategy useful for select patients experiencing osimertinib-induced hypersensitivity reactions. It also demonstrates that if there is prolonged disruption to treatment, a second desensitisation can be completed successfully in the same patient so effective treatment in NSCLC may be continued.
期刊介绍:
The purpose of this document is to describe the structure, function and operations of the Journal of Pharmacy Practice and Research, the official journal of the Society of Hospital Pharmacists of Australia (SHPA). It is owned, published by and copyrighted to SHPA. However, the Journal is to some extent unique within SHPA in that it ‘…has complete editorial freedom in terms of content and is not under the direction of the Society or its Council in such matters…’. This statement, originally based on a Role Statement for the Editor-in-Chief 1993, is also based on the definition of ‘editorial independence’ from the World Association of Medical Editors and adopted by the International Committee of Medical Journal Editors.