Wu Ka, Guo Chao, Li Rong
Department of Pharmacy, The Second People's Hospital of Nanning City, The Third Affiliated Hospital of Guangxi Medical University, Guangxi, Nanning.
Department of Pharmacy, Guigang City People's Hospital, The Eighth Affiliated Hospital of Guangxi Medical University, Guigang, Guangxi.
Medicine (Baltimore). 2019 May;98(18):e15489. doi: 10.1097/MD.0000000000015489.
Mounting evidences reveal that mutation of epidermal growth factor receptor (EGFR) may induce the resistance of tyrosine kinase inhibitors (TKIs). TKI-resistant lung cancer cells are sensitive to inhibition of the EGFR pathway. This case report aimed to characterize the therapeutic benefits of erlotinib, a targeted drug, on an advanced lung cancer patient with somatic EGFR mutation.
A 52-year-old non-smoking Chinese woman was suffered from pneumonia-based chest pains, and the patient was diagnosed as advanced lung cancer through medical imaging, thoracoscopy, and pathological examination.
Blood tests, pathological examination, thoracoscopy, computed tomography (CT)/positron emission computed tomography (PET) scans, next-generation sequencing (NGS) testing were subjected to the patient's samples before and after targeted drug treatments.
After icotinib-induced resistance, the chemoresistance mechanism was involved in EGFR mutations before being prescribed with erlotinib.
The therapeutic effectiveness of icotinib for 4-month showed undetected carcinomatous metastasis. The lung tumor sizes were reduced, and improved quality of life (QOL) was described by the patient. Followed by monotherapy with erlotinib for 1.5-year, the icotinib-resistant patient benefited from longer survival rate without tumor enlargement and neoplastic metastasis. In therapeutic duration of erlotinib, T790M mutation of EGFR, R248W mutation of tumor protein p53 (TP53), K844S mutation of retinoblastoma protein 1 (RB1) were identified through NGS test.
In conclusion, the anti-cancer benefits of icotinib and erlotinib against advanced lung cancer may contribute to suppress neoplastic growth and metastasis. Further, erlotinib exerts potent efficacy for extended survival rate of patient because detectable mutations may not or limitedly induce erlotinib-resistance. In addition, reduced circulating hormones by menopause may enhance the therapeutic effectiveness of erlotinib.
越来越多的证据表明，表皮生长因子受体（EGFR）突变可能会导致对酪氨酸激酶抑制剂（TKIs）产生耐药性。对TKI耐药的肺癌细胞对EGFR通路的抑制敏感。本病例报告旨在描述靶向药物厄洛替尼对一名患有体细胞EGFR突变的晚期肺癌患者的治疗效果。
一名52岁不吸烟的中国女性患有以肺炎为基础的胸痛，通过医学影像、胸腔镜检查和病理检查，该患者被诊断为晚期肺癌。
在靶向药物治疗前后，对患者的样本进行了血液检测、病理检查、胸腔镜检查、计算机断层扫描（CT）/正电子发射断层扫描（PET）以及二代测序（NGS）检测。
在埃克替尼诱导耐药后，在给予厄洛替尼之前，化疗耐药机制与EGFR突变有关。
埃克替尼治疗4个月的疗效显示未检测到癌转移。肺部肿瘤大小缩小，患者自述生活质量（QOL）得到改善。随后单药使用厄洛替尼治疗1.5年，对埃克替尼耐药的患者受益于更长的生存率，肿瘤未增大且无肿瘤转移。在厄洛替尼治疗期间，通过NGS检测鉴定出EGFR的T790M突变、肿瘤蛋白p53（TP53）的R248W突变、视网膜母细胞瘤蛋白1（RB1）的K844S突变。
总之，埃克替尼和厄洛替尼对晚期肺癌的抗癌益处可能有助于抑制肿瘤生长和转移。此外，厄洛替尼对延长患者生存率具有显著疗效，因为可检测到的突变可能不会或有限地诱导对厄洛替尼的耐药性。此外，绝经导致循环激素减少可能会增强厄洛替尼的治疗效果。
