Managing Lung Inflammation After Chemoradiation and Tagrisso

Patients with stage 3 lung cancer often receive chemotherapy and radiation, which can cause lung inflammation known as radiation pneumonitis, according to Dr. Suresh S. Ramalingam.

Dr. Suresh Ramalingam is a board-certified medical oncologist specializing in small cell and non-small cell lung cancer. He serves as executive director of Winship Cancer Institute of Emory University, as well as associate vice president for cancer of Woodruff Health Sciences Center, and holds the Roberto C. Goizueta Distinguished Chair for Cancer Research.

Signs of pneumonitis include a worsening cough, shortness of breath or fever. These symptoms are typically manageable with a short course of steroids, and many patients can restart Tagrisso once they recover.

When the targeted therapy osimertinib (Tagrisso) is added afterward, doctors watch closely for this side effect. The LAURA study found that while pneumonitis occurred slightly more often in patients taking Tagrisso, most cases were mild.

Updated findings from the LAURA study suggest that treatment with Tagrisso may improve overall survival for patients with unresectable, stage 3 non-small cell lung cancer with EGFR mutations. Median overall survival was 58.8 months for patients who received Tagrisso versus 54.1 months for those who received placebo, despite most patients in the placebo group later receiving Tagrisso after their disease progressed. The trial is ongoing and will continue to monitor overall survival as a key endpoint.

Transcript:

One of the unique aspects of the stage 3 disease patient population is that these patients are treated with chemotherapy and radiation. A common side effect of radiation is pneumonitis, or lung inflammation. When Tagrisso is added to this regimen, a concern arose about whether it would worsen this side effect.

The findings of the LAURA study were reassuring in this regard. In the patient population that received both placebo and Tagrisso, the most common side effect was radiation pneumonitis, even with Tagrisso exposure. While there were numerically slightly more cases of radiation pneumonitis reported in the Tagrisso group, they were relatively mild. None were severe enough to fundamentally change how we think about the role of Tagrisso in this setting.

So, the key takeaway is that radiation pneumonitis can occur after chemotherapy and radiation. Physicians and patients need to be aware of this. If patients develop symptoms like worsening shortness of breath, increased cough, or fever, they need to report it to their physician. In most instances, these symptoms can be easily treated with a short course of steroids, and the symptoms should improve. In fact, in the LAURA study, when we had to interrupt treatment with Tagrisso, we were able to resume it in a high majority of patients after their symptoms improved.

Transcript has been edited for clarity and conciseness.

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