Department of Radiation Oncology, Quzhou People's Hospital, Quzhou, 324000, Zhejiang, China.
Department of Medical Oncology, Quzhou People's Hospital, No. 2 Zhongloudi Road, Quzhou, 324000, People's Republic of China.
BMC Cancer. 2019 Feb 8;19(1):131. doi: 10.1186/s12885-019-5352-7.
Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) have been emerged as the standard selection in non-small cell lung cancer (NSCLC) patients with EGFR sensitive mutations. However, primary or acquired resistance to EGFR-TKIs seems inevitable, especially to third-generation TKIs, which has appeared absence of effective solutions so far.
Here we reported a NSCLC patient with EGFR sensitive mutation of deletion within EGFR exon 19, who had been resistant to icotinib and AZD9291 successively after a period of 18 months response duration. Next-generation sequencing (NGS) technique using plasma sample suggested an acquired EGFR Leu792H mutation, rather than C797S one. Interestingly, the patient obtained another 8 months of disease-free duration with symptoms greatly relieved after repeating icotinib administration. The overall survival of the patient has been thirty-six months and still in the extension.
The presentation of the case may provide some selective therapeutic thoughts for NSCLC patients with acquired EGFR Leu792H mutation suffering resistance to the third-generation TKIs.
表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）已成为具有 EGFR 敏感突变的非小细胞肺癌（NSCLC）患者的标准选择。然而，对 EGFR-TKIs 的原发性或获得性耐药似乎不可避免，尤其是对于第三代 TKI，迄今为止还没有出现有效的解决方案。
在这里，我们报告了一名 NSCLC 患者，其 EGFR 外显子 19 内缺失 EGFR 敏感突变，在 18 个月的缓解期后，他对厄洛替尼和阿兹替尼相继耐药。使用血浆样本的下一代测序（NGS）技术提示获得性 EGFR Leu792H 突变，而非 C797S 突变。有趣的是，该患者重复厄洛替尼治疗后，症状明显缓解，又获得了 8 个月的无疾病生存期。该患者的总生存期为 36 个月，仍在扩展中。
该病例的介绍可能为第三代 TKI 耐药后获得性 EGFR Leu792H 突变的 NSCLC 患者提供了一些选择性治疗思路。
