Icotinib treatment for EGFR-mutated NSCLC may be associated with rare treatment-related myeloid neoplasmIcotinib Treatment for Lung Cancer Linked to Rare Blood Condition

Icotinib significantly improves survival and prognosis in patients with epidermal growth factor receptor (EGFR)-sensitive non-small cell lung cancer (NSCLC). It is generally well-tolerated, with treatment-related myeloid neoplasm (t-MN) being a rare adverse reaction. We report a case of a 75-year-old female patient with lung adenocarcinoma (EGFR exon 21 L858R mutation) who underwent four cycles of pemetrexed combined with platinum-based chemotherapy postoperatively, followed by radiation therapy to the supraclavicular and mediastinal lymphatic drainage regions, and sequential targeted therapy with icotinib. Approximately 32 months after initiating icotinib, the patient developed severe anemia, leading to discontinuation of the drug. She was subsequently diagnosed with acute myeloid leukemia (AML) and treated with a regimen of lisaftoclax combined with azacitidine; bone marrow examination after one cycle of treatment showed partial remission. The patient later experienced relapse and progression of AML and died 4 months after the AML diagnosis. We also reviewed previous cases of t-MN induced during treatment with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). Based on this literature review, it remains unclear whether EGFR-TKIs are independent risk factors for t-MN. This study suggests that patients with NSCLC receiving EGFR-TKIs should undergo long-term, regular monitoring of complete blood counts. Clinicians should be vigilant for the risk of t-MN in patients with persistent cytopenia and should identify such cases and intervene as early as possible.