Gefitinib treatment after exfoliative dermatitis induced by sequential aumolertinib and furmonertinib in lung adenocarcinoma: a case report.

This case report describes a 74-year-old female patient with lung adenocarcinoma harboring an EGFR exon 21 L858R variant and brain metastases. During sequential treatment with two third-generation epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), aumolertinib (formerly known as almonertinib) and furmonertinib, the patient developed severe exfoliative dermatitis (ED). Given the patient's poor performance status, chemotherapy was declined, and treatment was subsequently switched to the first-generation EGFR-TKI gefitinib. Gefitinib was well tolerated, and no recurrence of cutaneous reactions was observed. Follow-up chest computed tomography demonstrated stable disease, with disease control maintained for more than four months. This case highlights the importance of careful monitoring for severe and potentially life-threatening cutaneous adverse reactions, including ED, during treatment with third-generation EGFR-TKIs. The clinical course also suggests differences in cutaneous toxicity profiles among EGFR-TKIs of different generations. For patients who develop severe cutaneous toxicity with third-generation EGFR-TKIs, switching to a first-generation EGFR-TKI may represent a safe, feasible, and effective therapeutic alternative.