Taniguchi Yuri, Horiuchi Hajime, Morikawa Teppei, Usui Kazuhiro
Division of Respirology, NTT Medical Center Tokyo, Tokyo, Japan.
Department of Diagnostic Pathology, NTT Medical Center Tokyo, Tokyo, Japan.
Case Rep Oncol. 2018 May 29;11(2):323-329. doi: 10.1159/000489603. eCollection 2018 May-Aug.
There are various mechanisms underlying the resistance of EGFR-mutant lung adenocarcinoma to epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). We herein report a case of pulmonary adenocarcinoma with EGFR mutation (exon 19 deletion and T790M) that acquired resistance to osimertinib treatment because of transformation into small-cell lung carcinoma (SCLC). A 67-year-old ex-smoking woman was diagnosed with left upper lobe adenocarcinoma of clinical stage IIIA (cT2bN2M0). She was treated with chemoradiotherapy (cisplatin and vinorelbine plus radiation), gefitinib, cisplatin, and pemetrexed followed by pemetrexed maintenance therapy and erlotinib. Since a sample extracted from the metastatic lung tumor taken obtained via a transbronchial lung biopsy was found to be positive for the T790M mutation at the time of disease progression during erlotinib treatment, she received osimertinib treatment for 15 months until progressive disease. She developed resistance to osimertinib due to the histologic transformation to SCLC. Although the standard chemotherapy of carboplatin and etoposide for SCLC was administered, she died due to metastatic liver failure.
表皮生长因子受体（EGFR）突变的肺腺癌对表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）产生耐药的机制多种多样。我们在此报告一例发生EGFR突变（第19外显子缺失和T790M）的肺腺癌病例，该病例因转化为小细胞肺癌（SCLC）而对奥希替尼治疗产生耐药。一名67岁的已戒烟女性被诊断为临床ⅢA期（cT2bN2M0）左上叶腺癌。她接受了放化疗（顺铂和长春瑞滨联合放疗）、吉非替尼、顺铂和培美曲塞治疗，随后接受培美曲塞维持治疗和厄洛替尼治疗。在厄洛替尼治疗期间疾病进展时，经支气管肺活检获取的转移性肺肿瘤样本检测发现T790M突变呈阳性，因此她接受了15个月的奥希替尼治疗，直至疾病进展。由于组织学转变为SCLC，她对奥希替尼产生了耐药。尽管给予了SCLC的标准化疗方案卡铂和依托泊苷，但她最终因肝转移衰竭而死亡。
