Jovanovic Dragana, Stevic Ruza, Velinovic Marta, Kontic Milica, Maric Dragana, Spasic Jelena, Radosavljevic Davorin
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
University Hospital of Pulmonology, Clinical Center of Serbia, Belgrade, Serbia.
Onco Targets Ther. 2017 Sep 6;10:4347-4354. doi: 10.2147/OTT.S131756. eCollection 2017.
This paper presents a rare case of an elderly patient treated with erlotinib for disseminated lung adenocarcinoma with poor performance status (Eastern Cooperative Oncology Group performance status [PS]3). This treatment led to a long duration of complete remission according to Response Evaluation Criteria in Solid Tumors 1.1 - almost 7 years (81 months) of progression-free survival (PFS) and overall survival (OS) of 10 years by March 2017. The treatment with erlotinib started in September 2008 and it was well tolerated with no adverse effects. Mutation analyses (real-time polymerase chain reaction method) revealed deletion of (epidermal growth factor receptor) gene and wild-type Kirsten-ras protein gene in exon 19. In May 2015, the patient relapsed with jaundice and enlarged lymph nodes of the liver hilum, with no other metastasis, PS 2. Biopsy confirmed metastasis of lung adenocarcinoma. EGFR molecular testing did not reveal T790M mutation. Treatment was continued with gemcitabine-cisplatin chemotherapy. A total of six cycles were administered with nearly complete response and Eastern Cooperative Oncology Group performance status 0. Further on, gemcitabine monotherapy has been administered with nearly complete response maintained and OS of 10 years by March 2017. This report describes an extremely rare case of a poor performance patient with advanced metastatic adenocarcinoma harboring EGFR mutation - deletion in exon 19 - who was receiving salvage erlotinib and had a complete response with 81 months of PFS followed by a relapse and subsequent chemotherapy which led to nearly complete response, with an OS of 10 years by March 2017. Such a complete response to tyrosine kinase inhibitor therapy in a poor PS patient, with long PFS and OS achieved, justifies tyrosine kinase inhibitor treatment approach in poor PS patients with EGFR-sensitizing tumors, and furthermore points to the feasibility of administering chemotherapy at the time of relapse.
本文报告了一例罕见的老年患者，该患者因广泛期肺腺癌且体能状态较差（东部肿瘤协作组体能状态[PS]3）接受厄洛替尼治疗。根据实体瘤疗效评价标准1.1，该治疗带来了较长时间的完全缓解——至2017年3月无进展生存期（PFS）近7年（81个月），总生存期（OS）达10年。厄洛替尼治疗于2008年9月开始，耐受性良好，未出现不良反应。突变分析（实时聚合酶链反应法）显示外显子19中表皮生长因子受体（EGFR）基因缺失， Kirsten-鼠肉瘤病毒癌基因同源物（K-ras）蛋白基因野生型。2015年5月，患者复发，出现黄疸和肝门淋巴结肿大，无其他转移，PS为2。活检证实为肺腺癌转移。EGFR分子检测未发现T790M突变。继续采用吉西他滨-顺铂化疗。共进行了6个周期的化疗，获得了近乎完全缓解，东部肿瘤协作组体能状态为0。此后，给予吉西他滨单药治疗，维持了近乎完全缓解，至2017年3月OS达10年。本报告描述了一例极为罕见的病例，该晚期转移性腺癌患者体能状态差，存在EGFR突变——外显子19缺失，接受挽救性厄洛替尼治疗后获得完全缓解，PFS达81个月，随后复发并接受后续化疗，获得了近乎完全缓解，至2017年3月OS达10年。这样一名体能状态差的患者对酪氨酸激酶抑制剂治疗产生完全缓解，并实现了较长的PFS和OS，证明了对于EGFR敏感肿瘤且体能状态差的患者采用酪氨酸激酶抑制剂治疗方法的合理性，此外还表明了复发时进行化疗的可行性。
