Radiotherapy and Drug Therapy Center, Institute of Oncology, Vilnius University, San-tariškių 1, 08660 Vilnius, Lithuania.
Medicina (Kaunas). 2011;47(9):520-5. Epub 2011 Dec 2.
A case of successful and prolonged treatment of metastatic non-small cell lung cancer with the epidermal growth factor receptor antagonist erlotinib is presented. A never-smoker female was diagnosed with stage IV lung cancer in December 2005. A chest CT scan showed soft tissue mass 35×34 mm in size in the right lung with metastases in the lymph nodes and in the left lung. A biopsy revealed a poorly differentiated adenocarcinoma. The disease showed poor response to the first-line and second-line chemotherapy. Targeted therapy with erlotinib was started in February 2007. The most severe adverse event observed was grade 3 skin rash. The disease was stable until February 2009 when brain metastases were detected. Erlotinib was continued until May 2009 when disease progression in the lungs was confirmed. The patient died due to ongoing disease progression in December 2009. Retrospective genetic analysis of a tumor specimen was performed, and no mutations in EGFR exons 18-21 were detected. The patient had a significant clinical benefit for the period of 24 months. These results are consistent with previous reports in literature that clinical characteristics such as female gender, nonsmoker, adenocarcinoma histology, and severe cutaneous toxicity seem to predict good response to erlotinib. In the present case, erlotinib proved to be effective even in heavily pretreated, chemotherapy-resistant lung adenocarcinoma. So far, no exact predictive biomarkers of erlotinib effectiveness have been determined; and their further analyses are essential.
本文报道了一例表皮生长因子受体拮抗剂厄洛替尼成功治疗转移性非小细胞肺癌并延长患者生存时间的病例。一名从不吸烟的女性于 2005 年 12 月诊断为 IV 期肺癌。胸部 CT 扫描显示右肺软组织肿块大小为 35×34mm，并伴有淋巴结和左肺转移。活检显示为低分化腺癌。该患者对一线和二线化疗反应不佳。2007 年 2 月开始进行厄洛替尼靶向治疗。观察到的最严重的不良反应为 3 级皮疹。疾病一直稳定，直到 2009 年 2 月发现脑转移。继续使用厄洛替尼，直到 2009 年 5 月肺部疾病进展得到确认。患者于 2009 年 12 月死于疾病进展。对肿瘤标本进行回顾性基因分析，未发现 EGFR 外显子 18-21 突变。该患者在 24 个月内获得了显著的临床获益。这些结果与文献中的先前报道一致，即临床特征如女性、不吸烟、腺癌组织学和严重皮肤毒性似乎预示着对厄洛替尼的良好反应。在本病例中，厄洛替尼在经过大量预处理的化疗耐药肺腺癌中也显示出疗效。迄今为止，尚未确定厄洛替尼疗效的确切预测生物标志物，进一步分析这些标志物至关重要。
