S4375 Adagrasib (Krazati®)-Induced Esophageal Dysmotility in the Treatment of Non-Small Cell Lung Cancer

Introduction: Adagrasib (Krazati®) is an inhibitor of the KRAS gene product found on mutated oncogenes commonly seen in various cancers. It is an oral chemotherapy medication approved for the treatment of local or metastatic non-small cell lung cancer. The most common side effects are nausea, diarrhea, vomiting and fatigue. Our case highlights a patient receiving Adagrasib for KRAS-G12C positive mutation stage IVB lung adenocarcinoma with solitary metastasis to the brain presenting with esophageal dysmotility, decreased oral intake and weight loss. The case highlights the improvement of symptoms with use of metoclopramide, a dopamine receptor antagonist that boosts gastric motility. Case Description/Methods: Our patient is a 75-year-old man presenting with a spiculated mass in the left upper lobe and mildly enlarged lymph nodes suspicious of a primary lung malignancy. Imaging revealed sclerotic lesions in the left acetabulum, left sacral ala and two ribs. Brain magnetic resonance imaging showed a 1 × 1.1 × 1.2 cm T2 hyper-intense area in the inferior right occipital lobe cortex. EBUS samples from station 4 L lymph node, left upper lobe bronchial brushing and washings were positive for malignant cells consistent with primary lung adenocarcinoma. The patient was started on 6 weeks of chemoradiation with carboplatin/paclitaxel, followed by gamma knife radiation to the occipital lobe lesion. Shortly after adagrasib therapy was initiated, the patient experienced loss of appetite and hypotension requiring biweekly intravenous fluid administration. He was brought to the hospital for decreased oral intake secondary to dysphagia. A barium swallow study revealed poor esophageal motility with numerous tertiary contractions, causing slow and delayed esophageal emptying into the stomach. The patient was started on metoclopramide 10 mg before meals and at bedtime, which vastly improved esophageal motility, and his oral intake improved. Discussion: Maintaining the balance of nutritional status in cancer patients is of utmost importance to promote healing, overcome negative side effects of chemotherapy agents, as well as combat anorexia and cachexia commonly seen in this population. Our case highlights esophageal dysmotility associated with adagrasib therapy in our patient with stage IVB lung adenocarcinoma. Treating the esophageal dysmotility with mealtime and bedtime metoclopramide improved our patient’s oral intake, improved mentation and contributed to overall healing of the patient despite grim circumstances of his disease.