Thrombocytopenia Induced by Overdose of Osimertinib:A Case Report and Literature Analysis
Objective To provide a reference for the safe use of osimertinib in clinical practice.Methods The treatment process of a patient with left lung adenocarcinoma and epidermal growth factor receptor(EGFR)p.L858R gene mutation experiencing thrombocytopenia induced by overdose of osimertinib in the Shandong Provincial Hospital Affiliated to Shandong First Medical University was retrospectively analyzed.The relevant literature in the PubMed,CNKI,WanFang,VIP and others from the inception of these databases to April 25,2023 was searched to explore the mechanism of this adverse drug reaction(ADR)and clinical countermeasures.Results After taking 80 mg/d of osimertinib for more than two years,the patient developed meningeal metastasis,and thrombocytopenia(grade three)occurred when she took at a more dosage of 160 mg/d for 24 d.The ADR was considered to be probably related to the overdose of osimertinib(the Naranjo's ADR evaluation scale was seven points),so the osimertinib was discontinued,and then the patient's platelet count returned to the normal after 16 d.Literature analysis showed that the possible mechanisms of thrombocytopenia induced by osimertinib included interference with platelet generation or activation,possible pathogenic feedback pathways between suppressed tumor cells and platelets,and effects on endogenous thrombopoietin level.When this ADR occurred,we should stop the relevant drugs or reduce the dosage,and give the treatment such as recombinant human interleukin-11 or recombinant human thrombopoietin.Conclusion For patients with meningeal metastasis,high-dose osimertinib can effectively improve blood-brain barrier permeability and inhibit tumor growth.However,during the overdose use of osimertinib,clinical medical personnel need to pay more attention to the occurrence of thrombocytopenia,enhance the awareness of safe medication,and give the timely and symptomatic treatment based on the patient's condition.
tyrosine kinase inhibitorosimertiniboverdosethrombocytopeniaepidermal growth factor receptorgene mutationpharmaceutical care
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