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Case Report
Rapid-onset and fatal pneumonitis from trametinib treatment of non-small cell lung cancer: A case report
1 James P Wilmot Cancer Institute, Division of Hematology/Oncology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
2 James P Wilmot Cancer Institute, Division of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
Address correspondence to:
Seyed Mohammad Abedi
James P Wilmot Cancer Institute, Division of Hematology/Oncology, University of Rochester School of Medicine and Dentistry, Rochester, New York,
USA
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Article ID: 100077Z10SA2021
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Abedi SM, Lekkala M, Chen Y, Baumgart M, Patel A. Rapid-onset and fatal pneumonitis from trametinib treatment of non-small cell lung cancer: A case report. J Case Rep Images Oncology 2021;7:100077Z10SA2021.ABSTRACT
Introduction: Lung cancer remains the leading cause of death in both men and women worldwide. Oral targeted therapy remains the recommended first-line approach for those with actionable mutations. The combination of trametinib and dabrafenib has shown durable responses as both a first line and second line treatment in patients with non-small cell lung cancer (NSCLC) with a BRAFV600E mutation. Respiratory complications with trametinib have rarely been documented, with an incidence of less than 2%.
Case Report: A 58-year-old former female smoker who presented with dyspnea on exertion and was found to have a right hilar mass. The mass was biopsied and found to be a poorly differentiated carcinoma consistent with NSCLC. Tumor proportion score (TPS) was 100% for programmed death-ligand 1 (PD-L1) expression, and molecular analysis confirmed a BRAFV600E mutation. She was started on treatment with dabrafenib 150 mg twice daily with trametinib 2 mg once daily. After ten days, she developed fever followed by leukocytosis and hypoxia. Chest imaging was suggestive of pneumonitis, and she was initiated on high-dose steroids and antibiotics. Her cultures remained negative, though she was unable to be weaned from high-flow oxygen. She transitioned to hospice care several days later and subsequently passed in another 12 days.
Conclusion: Trametinib-induced interstitial pneumonitis, while a relatively rare occurrence, can become rapidly life-threatening and should prompt immediate cessation of the medication followed by urgent supportive care measures.
Keywords: Drug hypersensitivity, Lung neoplasms, NSCLC, Pneumonitis, Trametinib
SUPPORTING INFORMATION
Author Contributions
Seyed Mohammad Abedi - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Final approval of the version to be published
Manidhar Lekkala - Acquisition of data, Analysis of data, Drafting the article, Final approval of the version to be published
Yuhchyau Chen - Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Megan Baumgart - Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Arpan Patel - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Seyed Mohammad Abedi et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
