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EGFR TKI Toxicity — SCE Medical Oncology MCQ

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ModerateImmunotherapy & Targeted TherapyEGFR TKI ToxicitySCE Medical Oncology

A 55-year-old woman with EGFR-mutant NSCLC on osimertinib develops grade 2 interstitial lung disease (ILD) confirmed on CT (new bilateral ground-glass opacities). She is mildly symptomatic. What is the management?

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Correct answer: C — Permanently discontinue osimertinib and start corticosteroids

ILD/pneumonitis is a rare but potentially fatal class-effect toxicity of EGFR TKIs, including osimertinib (occurring in approximately 3-4%). For grade 2 or higher ILD, osimertinib should be permanently discontinued (not dose-reduced or rechallenged). Corticosteroids (prednisolone 0.5-1 mg/kg/day) should be started with slow taper over 4-6 weeks. Switching to another EGFR TKI carries risk of cross-reactivity for ILD and should be done with extreme caution if at all.

Reference: BNF Osimertinib monograph; NICE TA654 Osimertinib SPC; ESMO 2024 NSCLC Guidelines