Yang Tao, Xu Rui, Yan Bing, Li Fang, Liu Hui
Department of Oncology, Hainan Branch of PLA general hospital, Sanya , China.
Medicine (Baltimore). 2018 Dec;97(52):e13797. doi: 10.1097/MD.0000000000013797.
Although most of non-small cell lung cancer (NSCLC) patients with ROS1-fusions respond to crizotinb, acquired resistance eventually develop. The next-generations of ROS1 inhibitors have made some achievements, but the effects of immunotherapy have not been explored.
A 44-year-old Chinese women presented with cough and dyspnea with a history of advanced lung adenocarcinoma.
A PET/CT scan revealed primary tumors in bilateral lung lobes and multiple metastases in lymph nodes and bones. And ultrasound-guided left cervical lymph node biopsy revealed the pathological diagnosis was poor differentiated lung adenocarcinoma.
The patients was started to be treated with 4 cycles of pemetrexed, carboplatin and bevacizumab, followed by one cycle of docetaxel, cisplatin and bevacizumab. As the ROS1-fusion was found by next generation sequencing, the patient received crizotinib treatment about 3 months.
After 5 cycles of chemotherapy, CT scans revealed increased size of bilateral lobe nodules indicative of progressive disease (PD). Then the patient received treatment of crizotinib and his progression-free survival reached 3 months. Due to uncontrollable disease progression, the patient expired.
The genetic profile of NSCLC patients might be altered in various therapeutic processes. Thus, repeated genetic testing might be important at each progression. Moreover, immunotherapy might be a powerful weapon to overcome the resistance to Tyrosine kinase inhibitors (TKIs) in future.
尽管大多数ROS1融合的非小细胞肺癌（NSCLC）患者对克唑替尼有反应，但最终会出现获得性耐药。新一代ROS1抑制剂已取得一些成果，但免疫疗法的效果尚未得到探索。
一名44岁中国女性，因咳嗽和呼吸困难就诊，有晚期肺腺癌病史。
PET/CT扫描显示双侧肺叶有原发性肿瘤，淋巴结和骨骼有多处转移。超声引导下左颈部淋巴结活检显示病理诊断为低分化肺腺癌。
患者开始接受4个周期的培美曲塞、卡铂和贝伐单抗治疗，随后接受1个周期的多西他赛、顺铂和贝伐单抗治疗。由于下一代测序发现ROS1融合，患者接受了约3个月的克唑替尼治疗。
经过5个周期的化疗，CT扫描显示双侧肺叶结节增大，提示疾病进展（PD）。然后患者接受克唑替尼治疗，无进展生存期达到3个月。由于疾病进展无法控制，患者死亡。
NSCLC患者的基因特征可能在各种治疗过程中发生改变。因此，在每次疾病进展时重复进行基因检测可能很重要。此外，免疫疗法未来可能是克服对酪氨酸激酶抑制剂（TKIs）耐药性的有力武器。
