Benefit from Almonertinib after Osimertinib treat EGFR 19 exon deletion NSCLC induced Severe rash: a case report

Figures & data

Figure 1. The clinical course according to CT scan findings: (A) (B) March 2022: a truncation observed in the medial segmental bronchus of the right middle lobe, accompanied by a distal mass-like soft tissue lesion; (C) March 2022: Osteolysis of the right iliac bone; (D) (E) April 2022: the constriction in the medial segmental bronchus of the right middle lobe has intensified. Therapeutic assessments indicate a progressive SD; (F) June 2022 chest CT: a reduction in the size of the pulmonary focus in the lung; (G): August 2022 chest CT, two months after starting osimertinib, showed a reduced right middle lobe tumor, evaluated as PR; (H) November 2022: PR observed two months after initiating aumornertinib; (I) PR on aumornertinib in february 2023.

Figure 2. (A) (B) Two months after osimertinib treatment: multiple rashes in the extremities, no itching, pain, and hypoesthesia; (C) (D) (E) (F) Rash gradually subsided.

Figure 3. Treatment process.

Table 1. Characteristics of targeted therapy and immunotherapy for skin.

Immunotherapy		Targeted therapy
Characteristics	Treatmrent	Characteristics	Treatmrent
Trunk, limbs		Face, Chest wall
Exanthema maculosum, papula	Antihistamine, Hormones	Acneform eruptions	Autacoid
With itching, unique itching, No rash	Calamine	With itching, skin dryness, exfoliation, keratinizing squamous cell carcinoma	Vaseline
White spotting Alopecia areata	un-specificness	PPES	Loose clothes Local treatment
RCCEP	un-specificness	Photoallergy erythema	Sunscreen
Bullous dermatitis Stevens-Johnson syndrome Toxic epidermal necrolysis	Drug discontinuance Hospitalization	Erythema multiforme Stevens-Johnson syndrome Toxic epidermal necrolysis	Drug discontinuance Hospitalization

PPES: palmar-plantar erythrodysesthesia syndrome; RCCEP: reactive cutaneous capillary endothelial proliferation.