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奥希替尼(AZD9291)与两名未经放疗的EGFR突变且T790M阳性的晚期非小细胞肺癌患者的中枢神经系统反应

Osimertinib (AZD9291) and CNS Response in Two Radiotherapy-Naïve Patients with EGFR-Mutant and T790M-Positive Advanced Non-Small Cell Lung Cancer.

作者信息

Ricciuti Biagio, Chiari Rita, Chiarini Pietro, Crinò Lucio, Maiettini Daniele, Ludovini Vienna, Metro Giulio

机构信息

Department of Medical Oncology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, via Dottori 1, 06156, Perugia, Italy.

Department of Neuroradiology, Santa Maria della Misericordia Hospital, Azienda Ospedaliera di Perugia, Perugia, Italy.

出版信息

Clin Drug Investig. 2016 Aug;36(8):683-6. doi: 10.1007/s40261-016-0411-1.

Abstract

The discovery of sensitizing epidermal growth factor receptor (EGFR) mutations as a predictive marker of sensitivity to first-generation EGFR tyrosine kinase inhibitors (TKIs) has dramatically changed the paradigm of care for advanced non-small cell lung cancer (NSCLC) patients. Unfortunately, the majority of patients with EGFR-mutant NSCLC treated with EGFR-TKIs develop acquired resistance within 14-16 months. T790M mutation recently emerged as a major determinant of acquired resistance to gefitinib and erlotinib. Osimertinib (AZD9291) is a novel mono-anilino-pyrimidine third-generation EGFR TKI targeting both sensitizing and T790M EGFR-mutation which showed promising results in T790M-positive NSCLC. Here we report two cases of gefitinib- or erlotinib-pretreated NSCLCs with a T790M mutation-positive (as assessed on plasma through the therascreen EGFR test) disease and untreated, asymptomatic central nervous system metastases that responded to treatment with osimertinib.

摘要

致敏表皮生长因子受体(EGFR)突变作为第一代EGFR酪氨酸激酶抑制剂(TKIs)敏感性预测标志物的发现,极大地改变了晚期非小细胞肺癌(NSCLC)患者的治疗模式。不幸的是,大多数接受EGFR-TKIs治疗的EGFR突变NSCLC患者在14 - 16个月内出现获得性耐药。T790M突变最近成为对吉非替尼和厄洛替尼获得性耐药的主要决定因素。奥希替尼(AZD9291)是一种新型单苯胺基嘧啶第三代EGFR TKI,靶向致敏和T790M EGFR突变,在T790M阳性NSCLC中显示出有前景的结果。在此,我们报告两例经吉非替尼或厄洛替尼预处理、T790M突变阳性(通过therascreen EGFR检测在血浆中评估)的NSCLC病例,以及未经治疗、无症状的中枢神经系统转移灶,这些病例对奥希替尼治疗有反应。

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