Gu Haibo, Sun Li, Dou Zhengwei, Kong Chengying, Zu Jun, Xiao Jian, Jiang Tao, Li Ning
Department of Respiratory, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 310009, China.
Transl Lung Cancer Res. 2020 Apr;9(2):389-392. doi: 10.21037/tlcr.2020.03.11.
Lung adenocarcinoma is one of the most common types of lung cancer, and patients with epidermal growth factor receptor (EGFR) mutation-positive can be intervened with EGFR-TKI therapy to achieve longer survival. AURA3 study showed that patients resistant with the first generation of EGFR-TKI and with T790M mutation still received longer progression-free survival (PFS) after treatment with the third generation of EGFR-TKI osimertinib, and osimertinib also had a good effect on brain metastasis. Moreover, the FLAURA study published by the European Society of Medical Oncology (ESMO) in 2019 showed that the first line use of osimertinib could achieve a PFS of 18.9 months. In recent years, researches on lung cancer seem like blooming flowers. The new treatment mode for lung cancer treatment such as anti-angiogenic drugs, immunotherapy programs has satisfactory efficacy either alone or in combination. Notably, patients with lung adenocarcinoma often have single or multiple bone metastasis, which brings great suffering to patients, especially when metastases occurred in the weight-bearing bone. However, there is no solid evidence to prove that chemotherapy, targeted therapy, anti-angiogenic drugs, or immunotherapy have long-term efficacy in bone metastasis of lung adenocarcinoma. The present strategies for bone metastasis of lung cancer include of: palliative care, analgesia, improvement of bone metabolism, local radiotherapy, and radionuclide therapy. However, by far, no medical treatment has a significant advantage in inhibiting the course of bone metastasis in lung cancer at the source. In this case, patient with advanced lung adenocarcinoma and EGFR mutation was resistant with the first generation of EGFR-TKI treatment, and after detection of T790M mutation, we switched to osimertinib for primary disease control, bone metastasis was still obvious, and there was still no obvious effect after pain relief, bone metabolism improvement and local radiotherapy. This case is reported to suggest that further efforts in anti-tumor and palliative treatment in bone metastasis of lung adenocarcinoma are urgently needed.
肺腺癌是最常见的肺癌类型之一，表皮生长因子受体（EGFR）突变阳性的患者可接受EGFR-TKI治疗以获得更长生存期。AURA3研究表明，第一代EGFR-TKI耐药且伴有T790M突变的患者在接受第三代EGFR-TKI奥希替尼治疗后仍可获得更长的无进展生存期（PFS），且奥希替尼对脑转移也有良好疗效。此外，欧洲医学肿瘤学会（ESMO）2019年发表的FLAURA研究表明，一线使用奥希替尼可使PFS达到18.9个月。近年来，肺癌研究如繁花盛开。肺癌治疗的新治疗模式如抗血管生成药物、免疫治疗方案单独或联合使用均有满意疗效。值得注意的是，肺腺癌患者常发生单处或多处骨转移，给患者带来巨大痛苦，尤其是转移发生在负重骨时。然而，尚无确凿证据证明化疗、靶向治疗、抗血管生成药物或免疫治疗对肺腺癌骨转移有长期疗效。目前肺癌骨转移的治疗策略包括：姑息治疗、镇痛、改善骨代谢、局部放疗和放射性核素治疗。然而，到目前为止，尚无药物在从源头上抑制肺癌骨转移进程方面具有显著优势。在此病例中，一名晚期肺腺癌且EGFR突变患者第一代EGFR-TKI治疗耐药，检测到T790M突变后改用奥希替尼控制原发疾病，但骨转移仍很明显，经止痛、改善骨代谢及局部放疗后仍无明显效果。报道此病例旨在提示，迫切需要在肺腺癌骨转移的抗肿瘤及姑息治疗方面进一步努力。
