文章摘要

EGFR敏感突变晚期肺腺癌1例并文献复习

作者: 1顾海迪, 1王晨洁, 1杨军, 1王莹, 1谭洁
1 南京医科大学附属苏州医院,苏州市立医院东区肿瘤内科,江苏 苏州 215001
通讯: 谭洁 Email: 1959005821@qq.com
DOI: 10.3978/j.issn.2095-6959.2019.12.040

摘要

报告1例EGFR敏感突变晚期肺腺癌的60岁女性病例,该患者为左肺腺癌T2aN2M0IIIA期术后,手术标本EGFR检测示:19号外显子突变。术后完成培美曲塞联合顺铂辅助化疗4个疗程。2016年6月发现血清癌胚抗原586.49 ng/mL,进一步查正电子发射断层显像-X线计算机体层成像仪(positron emission tomography-computed tomography,PET-CT)提示肺癌伴纵膈及右肺门淋巴结转移、胸膜转移、多发骨转移。一线埃克替尼治疗15个月,疾病进展,2017年10月发现外周血T790M突变,二线奥希替尼治疗12个月,疾病再次进展。胸水二代测序显示T790M消失,EGFR 19外显子突变存在。三线予奥希替尼联合安罗替尼治疗。EFGR-TKI治疗对EGFR敏感突变的患者可以带来PFS及安全性等方面的获益,随着治疗线数的增加,后期耐药机制更加复杂,有待进一步研究使个体治疗更加精准。
关键词: 肺癌;表皮生长因子受体;酪氨酸激酶抑制剂;获得性耐药

Advanced lung adenocarcinoma with EGFR sensitive mutation: A case report and literature review

Authors: 1GU Haidi, 1WANG Chenjie, 1YANG Jun, 1WANG Ying, 1TAN Jie
1 Department of Medical Oncology, Eastern District of Suzhou Municipal Hospital, Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Jiangsu 215001, China

CorrespondingAuthor: TAN Jie Email: 1959005821@qq.com

DOI: 10.3978/j.issn.2095-6959.2019.12.040

Abstract

We report a case of advanced lung adenocarcinoma with epidermal growth factor receptor sensitive mutation. The patient was a 60-year-old female with left lung adenocarcinoma T2aN2M0IIIA stage, and surgical specimens EGFR detection showed exon 19 mutation. After the operation, 4 courses of pemetrexed combined with cisplatin adjuvant chemotherapy were completed. In June 2016, the blood carcinoembryonic antigen was found to be 586.49 ng/mL. Further examination of PET-CT indicated lung cancer with mediastinal and right hilar lymph node metastasis, pleural metastasis, and multiple bone metastasis. First-line icotinib treatment lasted 15 months, with disease progression. In October 2017, a mutation of T790M was found in peripheral blood. Second-line osimertinib was treated for 12 months, and the disease progressed again. Pleural effusion second generation sequencing showed T790M disappeared, EGFR 19 exon mutation existed. The third line was treated with osimertinib and anlotinib. EFGR-TKI treatment can benefit PFS and safety in patients with EGFR-sensitive mutations. With the increase of treatment lines, the drug resistance mechanism is more complicated, and further research is needed to make individual treatment more precise.
Keywords: lung cancer; epidermal growth factor receptor; tyrosine kinase inhibitor; acquired resistance