Division of Hematology and Oncology, Saint Martin De Porres Hospital, Chiayi City, Taiwan.
Division of Pathology, Saint Martin De Porres Hospital, Chiayi City, Taiwan.
Cancer Rep (Hoboken). 2020 Jun;3(3):e1243. doi: 10.1002/cnr2.1243. Epub 2020 Mar 12.
Small-cell lung cancer (SCLC) represents a group of highly fatal diseases with a tendency toward fast growth, early metastasis, and easy development of chemotherapy resistance. In the past 30 years, few advances have been made in the systemic treatment of SCLC, and cisplatin/etoposide has remained the standard of care for limited-stage SCLC and, in combination with radiotherapy, extensive-stage SCLC. The preferred metastatic sites of SCLC include the brain, liver, adrenal glands, bone, and bone marrow. However, bowel metastasis caused by SCLC is extremely rarely proved in patients while they are still alive (although autopsy studies suggest that silent metastases to the bowel are more common), and the standard treatment for bowel metastasis has never been reported. The mean time between the identification of gastrointestinal metastasis and mortality in patients with lung cancer is 100.6 days, with a range of 21-145 days.
We report the case of a patient with extensive SCLC (including brain metastasis), in which exon 19 deletion of epidermal growth factor receptor (EGFR) was detected. She initially refused chemotherapy and cranial radiotherapy and instead only agreed to oral target therapy. The second-generation EGFR-tyrosine kinase inhibitor (TKI), afatinib, was administered to the patient, and partial remission, including smaller metastatic brain tumors, was noted. Even though the subsequent development of rare metastatic lesions in the ascending and sigmoid colon was proved by colonoscopic biopsies, the prolonged overall survival (400 days) without standard treatment was marked in this case.
The patient with extensive metastasis of SCLC did not receive standard systemic chemotherapy. Instead, she initially received second-generation EGFR-TKI afatinib alone and later on whole brain radiotherapy as well (3 weeks before she expired). The prolonged overall survival of 400 days was marked and is worthy of sharing and further investigation.
小细胞肺癌（SCLC）是一组高度致命的疾病，具有生长迅速、早期转移和易发生化疗耐药的倾向。在过去的 30 年中，SCLC 的系统治疗几乎没有进展，顺铂/依托泊苷仍然是局限期 SCLC 的标准治疗方法，并且与放疗联合用于广泛期 SCLC。SCLC 的首选转移部位包括脑、肝、肾上腺、骨和骨髓。然而，SCLC 引起的肠道转移在患者仍存活时极难被证实（尽管尸检研究表明肠道的隐匿性转移更为常见），并且从未报道过肠道转移的标准治疗方法。肺癌患者胃肠道转移与死亡之间的平均时间为 100.6 天，范围为 21-145 天。
我们报告了一例广泛期 SCLC（包括脑转移）患者的病例，该患者检测出表皮生长因子受体（EGFR）外显子 19 缺失。她最初拒绝化疗和颅脑放疗，而只同意接受口服靶向治疗。给予第二代 EGFR 酪氨酸激酶抑制剂（TKI）阿法替尼治疗，发现包括较小的转移性脑肿瘤在内的部分缓解。尽管随后通过结肠镜活检证实了升结肠和乙状结肠的罕见转移性病变的发展，但在这种情况下，患者的总生存期（400 天）延长而无需标准治疗是显著的。
患有广泛转移的 SCLC 的患者未接受标准的全身化疗。相反，她最初单独接受了第二代 EGFR-TKI 阿法替尼治疗，后来还接受了全脑放疗（在她去世前 3 周）。总生存期延长至 400 天是显著的，值得分享和进一步研究。
