Gefitinib | Erlotinib | Afatinib | Osimertinib | COVID-19 Infection | |
---|---|---|---|---|---|
Incidence, (%) | Overall 1.3 1 Japan 1.6–4.3; non-Japanese 0.3–1 | 1.1%–4.3 | 1.6 | 3.9 | — |
Interval to onset | Median time 24–42 d; majority within 4–8 wk. | Median time 39 d; majority within 4 wk. | Median time 26.5 d (in Japan) | Median time 54 d (14–240 d) | Median incubation period of 5.1 d, with 97.5% becoming symptomatic within 11.5 d |
Mortality | 13%–50% 1 | 6.95% (to April 25, 2020) | |||
CXR | NA | 33.3%–69% patients positive with COVID-19 had abnormalities on CXR 3 47%–80% consolidation, 20%–38% GGO The severity of CXR peaked at 10–12 d from symptom onset. 3 | |||
Chest CT | Includes four patterns as below 2 A nonspecific area with GGO. A multifocal area of airspace consolidations. Patchy distribution of GGO accompanied by interlobar septal thickening. Extensive bilateral GGO or airspace consolidations with traction bronchiectasis. | Bilateral distribution of GGO with or without consolidation in posterior and peripheral lungs was the cardinal hallmark of COVID-19. Included the following patterns 4 :GGOs 14%–98%; consolidation 2%–64%; GGO + consolidation 19%–59%; interlobular septum thickening 1%–75%; reticular pattern 1%–22%; crazy paving 5%–36%; air bronchogram 21%–80%; bronchial wall thickening 11%–23%; pleural thickening 32%; subpleural line 20%; nodules 3%–13%; reversed halo sign 2%–3%; pleural effusion or pericardial effusion 1%–8%; lymphadenopathy 4%–8% | |||
Diagnosis | Diagnosis of EGFR TKI–associated interstitial pneumonitis is made essentially by exclusion of others | RT-PCR, isothermal amplification assays, serology tests | |||
Symptoms | Nonspecific, dyspnea 94.3%, fever 51.4%, cough 20%, asymptomatic 5.7% | Fever 85%–90%, cough 65%–70%, fatigue 35%–40%, sputum production 30%–35%, shortness of breath 15%–20%, myalgia or arthralgia 10%–15%, headaches 10%–36%, sore throat 10%–15%, chills 10%–12%. | |||
Treatment | Early detection, discontinue EGFR TKI, and start high-dose steroids as soon as possible. | No FDA-approved drugs as yet. Steroids may be harmful 5 |
References
- Tyrosine kinase inhibitor-induced interstitial lung disease: clinical features, diagnostic challenges, and therapeutic dilemmas.Drug Saf. 2016; 39: 1073-1091
- Imaging of gefitinib-related interstitial lung disease: multi-institutional analysis by the West Japan Thoracic Oncology Group.Lung Cancer. 2006; 52: 135-140
Wong HYF, Lam HYS, Fong AH, et al. Frequency and distribution of chest radiographic findings in COVID-19 positive patients [e-pub ahead of print]. Radiology. https://doi.org/10.1148/radiol.2020201160, accessed May 11, 2020.
Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review [e-pub ahead of print]. Eur Radiol. https://doi.org/10.1007/s00330-020-06801-0, accessed May 11, 2020.
- Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury.Lancet. 2020; 395: 473-475
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