case_images: PMC10626281_01
case_images: Time course of serum concentration of creatinine and treatment history. The lung cancer recurred, and treatment with gefitinib was started about 2 years after operation. The disease progressed one and half years after the start of gefitinib. Therefore, treatment was switched to afatinib. Serum creatinine concentration gradually increased over the course of that time, and hemodialysis was started. The disease progressed 3 months after the start of afatinib. A plasma test detected the T790M mutation, so treatment was switched to osimertinib.
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case_images: PMC10626281_01_cro-2023-0016-0001-531840_F01.jpg
case_images: F1
case_images: Figure 1 shows the time course of serum concentration of creatinine and his treatment history.
case_images: Therapeutic effect of osimertinib by CT evaluation. Before osimertinib treatment, CT showed a 22-mm nodule in the right upper lobe (a). At 8 weeks after starting osimertinib, the lesions disappeared on CT (b), and no regrowth was observed after 15 months (c).
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case_images: PMC10626281_01_cro-2023-0016-0001-531840_F02.jpg
case_images: F2
case_images: Before osimertinib treatment, CT showed a 22-mm nodule in the right upper lobe (Fig. 2a). At 8 weeks after starting osimertinib, the lesions disappeared on CT (Fig. 2b), and no regrowth was observed after 15 months (Fig. 2c).
case_images: Dosage of osimertinib and the course of its plasma concentration. The plasma concentration of osimertinib increased and reached 1,522.9 nM 20 weeks after the start of osimertinib. At 8 weeks after the dosage of osimertinib was reduced to three times a week (240 mg/week), the plasma concentration decreased to 560.8 nM; thus, the dosage was increased to four times a week (320 mg/week). However, plasma concentrations of osimertinib gradually decreased even after increasing dosage. Nine months after starting reduction of dosage, the plasma concentration decreased to 397.2 nM. The dosage was increased stepwise to 6 times a week (480 mg/week) with plasma concentration measurements.
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case_images: PMC10626281_01_cro-2023-0016-0001-531840_F03.jpg
case_images: F3
case_images: The dosage was increased stepwise to 6 times a week (480 mg/week) because there was concern that the antitumor effect might be weakened due to a decrease in the plasma concentration (Fig. 3).