Department of Pulmonary and Critical Care Medicine, Huashan Hospital, Fudan University, #12, Urumqi middle Road, Shanghai, 200040, China.
BMC Pulm Med. 2018 Jan 23;18(1):13. doi: 10.1186/s12890-018-0585-9.
Crizotinib is recommended as first-line therapy in ROS1-driven lung adenocarcinoma. However, the optimal first-line therapy for this subgroup of lung cancer is controversial according to the available clinical data.
Here, we describe a 57-year-old man who was diagnosed with stage IIIB lung adenocarcinoma and EGFR/KRAS/ALK-negative tumors. The patient received six cycles of pemetrexed plus cisplatin as first-line therapy and then pemetrexed as maintenance treatment, with a progression-free survival (PFS) of 42 months. The patient relapsed and underwent re-biopsy. EZR-ROS1 fusion mutation was detected by next-generation sequencing (NGS). The patient was prescribed crizotinib as second-line therapy and achieved a PFS of 6 months. After disease progression, lorlatinib was administered as third-line therapy, with a favorable response.
Prolonged PFS in patients receiving pemetrexed chemotherapy might be related to the EZR-ROS1 fusion mutation. Lorlatinib is an optimal choice in patients showing crizotinib resistance.
克唑替尼被推荐用于 ROS1 驱动的肺腺癌的一线治疗。然而，根据现有临床数据，ROS1 阳性肺腺癌的最佳一线治疗方案仍存在争议。
这里，我们描述了一名 57 岁男性患者，被诊断为 IIIB 期肺腺癌，且肿瘤 EGFR/KRAS/ALK 阴性。患者接受了六个周期培美曲塞联合顺铂的一线治疗，随后接受培美曲塞维持治疗，无进展生存期（PFS）为 42 个月。患者复发后进行了再次活检。下一代测序（NGS）检测到 EZR-ROS1 融合突变。患者接受克唑替尼二线治疗，PFS 为 6 个月。疾病进展后，给予洛拉替尼三线治疗，效果良好。
接受培美曲塞化疗的患者 PFS 延长可能与 EZR-ROS1 融合突变有关。对于出现克唑替尼耐药的患者，洛拉替尼是一个最佳选择。
