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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dermatomyositis &#40;DM&#41; is a well-known inflammatory myopathy usually associated with malignant diseases&#44; including lung cancer&#46; However&#44; there are few reports on epidermal growth factor receptor &#40;EGFR&#41; mutation-positive non-small cell lung cancer &#40;NSCLC&#41; complicated by DM&#59; EGFR mutations in these cases are uncommon&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a> Osimertinib is a third-generation EGFR-tyrosine kinase inhibitor &#40;TKI&#41; generally used as first-line treatment for common EGFR mutation &#40;i&#46;e&#46;&#44; exon 19 deletion&#47;L858R&#41;-positive NSCLC&#46; Osimertinib therapy for DM-associated NSCLC has not been reported previously&#46; Here&#44; we report a case of EGFR exon 19 mutation-positive DM-associated lung adenocarcinoma treated with osimertinib&#46; Informed consent was obtained from the patient&#44; and the study was conducted in accordance with the Helsinki Declaration&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 45-year-old Asian woman with a 26-pack-year smoking history presented with edema on her face and dorsal surface of her hands and feet&#44; erythema over both eyelids &#40;heliotrope rash&#44; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; papules on the dorsal surface of the hands &#40;Gottron&#39;s papules&#44; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#44; and muscle weakness in both legs&#46; She had a low-grade fever and both legs were tender to the touch&#46; She had left cervical lymphadenopathy&#46; Her serum creatine phosphokinase level was elevated &#40;161<span class="elsevierStyleHsp" style=""></span>U&#47;L&#41;&#44; and magnetic resonance imaging of her legs showed myositis and fasciitis&#46; Although the serum myositis-specific autoantibody levels were normal&#44; she was diagnosed with DM&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Computed tomography and &#91;18F&#93;-fluorodeoxyglucose positron emission tomography showed a pulmonary nodule in the right lung&#59; bilateral neck&#44; supraclavicular&#44; mediastinal&#44; and hilar lymphadenopathy&#59; and multiple hepatic nodules &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#44; D&#41;&#46; Her serum carcinoembryonic antigen level was elevated &#40;122&#46;2<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#41;&#46; A biopsy of a left cervical lymph node revealed an adenocarcinoma&#46; Immunohistochemical staining of the tumor specimen was positive for CK7 and TTF-1 and negative for p63 and the estrogen receptor&#46; These results suggested that the lung was the primary site of the adenocarcinoma&#46; Additional analysis of the tumor specimen revealed an EGFR mutation &#40;exon 19 deletion&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">After further investigation&#44; the patient was diagnosed with primary lung adenocarcinoma&#44; cT1bN3M1c&#44; stage IVB&#44; and DM&#46; Treatment with osimertinib and prednisolone 20<span class="elsevierStyleHsp" style=""></span>mg per day was initiated&#46; On follow-up three months later&#44; the tumor lesions had shrunk markedly&#44; and her serum carcinoembryonic antigen level was normal&#46; The symptoms of DM also improved&#46; She developed a mild rash as a side effect of osimertinib use but did not develop interstitial lung disease &#40;ILD&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In this case report&#44; we have presented two important clinical observations&#46; First&#44; common EGFR mutation-positive lung adenocarcinoma may occur in patients with DM&#46; To our knowledge&#44; this is the first English case report of common EGFR mutation-positive DM-associated NSCLC&#46; The most common histopathological type of DM-associated lung cancer is small-cell lung cancer &#40;44&#37;&#41;&#59; adenocarcinoma accounts for only 17&#37; of the cases&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> EGFR mutations are commonly associated with adenocarcinoma&#44; which may be the reason EGFR mutation-positive DM-associated NSCLC is extremely rare&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Second&#44; osimertinib may be safely used for EGFR mutation-positive NSCLC complicated with DM&#46; EGFR-TKIs have been reported to induce ILD at a higher rate than cytotoxic anticancer drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Moreover&#44; in a large multicenter clinical trial&#44; the incidence of ILD was reported to be higher in patients who received osimertinib than in those who received gefitinib&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> especially in the Japanese subset&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> As severe acute interstitial pneumonia often develops in DM patients&#44; clinicians may hesitate to use osimertinib for DM-associated NSCLC&#46; Our patient did not have DM-related ILD and did not develop osimertinib-induced ILD&#46; Therefore&#44; osimertinib may be used cautiously for patients with DM-associated NSCLC without DM-related ILD&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">It is speculated that the mechanism underlying osimertinib-induced ILD is different from that underlying first or second generation EGFR-TKIs and may be associated with T cell activity&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> More data should be accumulated to evaluate the safety of osimertinib therapy for NSCLC complicated with autoimmune diseases&#44; including DM&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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Scientific Letter
Osimertinib for the Treatment of EGFR Mutation-Positive Lung Adenocarcinoma Complicated With Dermatomyositis
El osimertinib como tratamiento del adenocarcinoma de pulmón con mutación positiva del EGFR complicado con dermatomiositis
Masahiro Yamasakia,
Corresponding author
myamasanjp@yahoo.co.jp

Corresponding author.
, Naoko Matsumotoa, Shota Nakanob, Kazuma Kawamotoa, Masaya Taniwakia, Yusuke Izumia, Masaya Otoharaa, Shinji Nabeshimac, Nobuyuki Ohashid, Noboru Hattoric
a Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, Japan
b Department of Rheumatology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Naka-ku, Hiroshima, Japan
c Department of Molecular and Internal Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, Minami-ku, Hiroshima, Japan
d Ohashi Clinic, Naka-ku, Hiroshima, Japan
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        "titulo" => "El osimertinib como tratamiento del adenocarcinoma de pulm&#243;n con mutaci&#243;n positiva del EGFR complicado con dermatomiositis"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#44; B&#41; Dermatological findings after the first examination of the patient&#46; &#40;A&#41; Visible erythema over both eyelids &#40;heliotrope rash&#41; with facial edema&#46; &#40;B&#41; Papules &#40;Gottron&#39;s papules&#41; and edema on the dorsal surface of the hands are visible&#46; &#40;C&#41; Chest computed tomography &#40;CT&#41; scan showing primary lesion in the right lung&#44; lower lobe &#40;arrow&#41;&#46; &#40;D&#41; Chest CT scan showing mediastinal lymphadenopathy&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Dermatomyositis &#40;DM&#41; is a well-known inflammatory myopathy usually associated with malignant diseases&#44; including lung cancer&#46; However&#44; there are few reports on epidermal growth factor receptor &#40;EGFR&#41; mutation-positive non-small cell lung cancer &#40;NSCLC&#41; complicated by DM&#59; EGFR mutations in these cases are uncommon&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1&#44;2</span></a> Osimertinib is a third-generation EGFR-tyrosine kinase inhibitor &#40;TKI&#41; generally used as first-line treatment for common EGFR mutation &#40;i&#46;e&#46;&#44; exon 19 deletion&#47;L858R&#41;-positive NSCLC&#46; Osimertinib therapy for DM-associated NSCLC has not been reported previously&#46; Here&#44; we report a case of EGFR exon 19 mutation-positive DM-associated lung adenocarcinoma treated with osimertinib&#46; Informed consent was obtained from the patient&#44; and the study was conducted in accordance with the Helsinki Declaration&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 45-year-old Asian woman with a 26-pack-year smoking history presented with edema on her face and dorsal surface of her hands and feet&#44; erythema over both eyelids &#40;heliotrope rash&#44; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; papules on the dorsal surface of the hands &#40;Gottron&#39;s papules&#44; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#44; and muscle weakness in both legs&#46; She had a low-grade fever and both legs were tender to the touch&#46; She had left cervical lymphadenopathy&#46; Her serum creatine phosphokinase level was elevated &#40;161<span class="elsevierStyleHsp" style=""></span>U&#47;L&#41;&#44; and magnetic resonance imaging of her legs showed myositis and fasciitis&#46; Although the serum myositis-specific autoantibody levels were normal&#44; she was diagnosed with DM&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Computed tomography and &#91;18F&#93;-fluorodeoxyglucose positron emission tomography showed a pulmonary nodule in the right lung&#59; bilateral neck&#44; supraclavicular&#44; mediastinal&#44; and hilar lymphadenopathy&#59; and multiple hepatic nodules &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#44; D&#41;&#46; Her serum carcinoembryonic antigen level was elevated &#40;122&#46;2<span class="elsevierStyleHsp" style=""></span>ng&#47;mL&#41;&#46; A biopsy of a left cervical lymph node revealed an adenocarcinoma&#46; Immunohistochemical staining of the tumor specimen was positive for CK7 and TTF-1 and negative for p63 and the estrogen receptor&#46; These results suggested that the lung was the primary site of the adenocarcinoma&#46; Additional analysis of the tumor specimen revealed an EGFR mutation &#40;exon 19 deletion&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">After further investigation&#44; the patient was diagnosed with primary lung adenocarcinoma&#44; cT1bN3M1c&#44; stage IVB&#44; and DM&#46; Treatment with osimertinib and prednisolone 20<span class="elsevierStyleHsp" style=""></span>mg per day was initiated&#46; On follow-up three months later&#44; the tumor lesions had shrunk markedly&#44; and her serum carcinoembryonic antigen level was normal&#46; The symptoms of DM also improved&#46; She developed a mild rash as a side effect of osimertinib use but did not develop interstitial lung disease &#40;ILD&#41;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">In this case report&#44; we have presented two important clinical observations&#46; First&#44; common EGFR mutation-positive lung adenocarcinoma may occur in patients with DM&#46; To our knowledge&#44; this is the first English case report of common EGFR mutation-positive DM-associated NSCLC&#46; The most common histopathological type of DM-associated lung cancer is small-cell lung cancer &#40;44&#37;&#41;&#59; adenocarcinoma accounts for only 17&#37; of the cases&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a> EGFR mutations are commonly associated with adenocarcinoma&#44; which may be the reason EGFR mutation-positive DM-associated NSCLC is extremely rare&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Second&#44; osimertinib may be safely used for EGFR mutation-positive NSCLC complicated with DM&#46; EGFR-TKIs have been reported to induce ILD at a higher rate than cytotoxic anticancer drugs&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> Moreover&#44; in a large multicenter clinical trial&#44; the incidence of ILD was reported to be higher in patients who received osimertinib than in those who received gefitinib&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a> especially in the Japanese subset&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">5</span></a> As severe acute interstitial pneumonia often develops in DM patients&#44; clinicians may hesitate to use osimertinib for DM-associated NSCLC&#46; Our patient did not have DM-related ILD and did not develop osimertinib-induced ILD&#46; Therefore&#44; osimertinib may be used cautiously for patients with DM-associated NSCLC without DM-related ILD&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">It is speculated that the mechanism underlying osimertinib-induced ILD is different from that underlying first or second generation EGFR-TKIs and may be associated with T cell activity&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">6</span></a> More data should be accumulated to evaluate the safety of osimertinib therapy for NSCLC complicated with autoimmune diseases&#44; including DM&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">This research did not receive any specific grant from funding agencies in the public&#44; commercial&#44; or not-for-profit sectors&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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                            0 => "J&#46;C&#46; Soria"
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                            2 => "N&#46; Nogami"
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        "texto" => "<p id="par0050" class="elsevierStylePara elsevierViewall">We would like to thank Editage &#40;<a target="_blank" href="http://www.editage.jp/">www&#46;editage&#46;jp</a>&#41; for English language editing&#46;</p>"
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Article information
ISSN: 15792129
Original language: English
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