病例报告：表皮生长因子受体 T790M 突变的厄洛替尼预处理肺腺癌患者对奥希替尼原发性耐药。
Case report: primary resistance to osimertinib in erlotinib-pretreated lung adenocarcinoma with EGFR T790 M mutation.
机构信息
Department of Oncology, Xinqiao Hospital, Army Medical University, Chongqing, 400037, China.
出版信息
BMC Cancer. 2018 Nov 6;18(1):1070. doi: 10.1186/s12885-018-4991-4.
BACKGROUND
Among non-small cell lung cancer (NSCLC) patients with acquired T790 M mutation resistance to first-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), 71% are likely to benefit from osimertinib. There have been several reports about the secondary resistance to osimertinib treatment in T790 M-positive patients, while primary resistance to osimertinib has been rarely reported.
CASE PRESENTATION
A 62-year-old Asian male never smoker who presented with stage IV EGFR L858R-positive adenocarcinoma developed EGFR T790 M mutation after 14 months of treatment with erlotinib combined with thoracic radiotherapy as first-line therapy. The patient was initiated on osimertinib treatment with T790 M mutation detected (14.4%), but disease progressed 2 months later.
CONCLUSION
The mechanism of primary resistance to osimertinib remains unclear. There may be an association between T790 M mutation disappearance, TP53 mutation and radiotherapy, but further researches are needed to confirm this.
背景
在接受第一代表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKI）治疗后出现获得性 T790M 耐药的非小细胞肺癌（NSCLC）患者中，有 71%可能受益于奥希替尼。已有多项关于 T790M 阳性患者对奥希替尼治疗产生继发性耐药的报道，而对奥希替尼原发性耐药的报道则很少。
病例介绍
一名 62 岁的亚洲男性，从不吸烟，患有 IV 期 EGFR L858R 阳性腺癌，在接受厄洛替尼联合胸部放疗作为一线治疗 14 个月后出现 EGFR T790M 突变。该患者开始接受奥希替尼治疗，检测到 T790M 突变（14.4%），但 2 个月后疾病进展。
结论
奥希替尼原发性耐药的机制尚不清楚。T790M 突变消失、TP53 突变和放疗之间可能存在关联，但需要进一步研究来证实这一点。
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