PMC8397522_01
Serum enzyme trend during treatment with osimertinib after chemotherapy + pembrolizumab and concomitant steroid therapy. The modification of liver enzymes indicated grade (G) 3 liver injury, with important alterations in alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), aspartate transaminase (AST) and alanine transaminase (ALT). Although the interruption of osimertinib and the concomitant use of steroids reduced the altered enzyme values, an insufficient interval between the adverse event and osimertinib rechallenge rapidly induced new toxicity that took several days to resolve.
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F1
Laboratory tests showed hepatotoxicity with a G3 increase in liver serum enzymes (Figure 1).
Cutaneous and mucosal involvement in Stevens-Johnson syndrome (day 45 of osimertinib). (A) Diffuse painful G3 erythema over the entire body upon hospital admission. The patient also had mucositis of the oral cavity (with blisters), pharynx (causing dysphagia), eyes, vagina, and nose (with ulcers causing episodes of epistaxis). SCORTEN score 3. (B) Reduction in the diffuse erythema, with areas of flaking and depigmentation (day 60).
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F2
Finally, a clinical diagnosis of Stevens-Johnson syndrome was made (Figure 2).
Brain response at CT scan. Comparison between baseline brain lesion at diagnosis and the impressive complete response after 3 months following chemoimmunotherapy and osimertinib. Osimertinib was only taken for a total of 37 days and then suspended because of severe toxicity.
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F3
A total body contrast-enhanced CT scan showed disease stability and complete response of brain lesions (day 60) (Figure 3).