Muto Satoshi, Ozaki Yuki, Okabe Naoyuki, Matsumura Yuki, Hasegawa Takeo, Shio Yutaka, Hashimoto Yuko, Suzuki Hiroyuki
Department of Chest Surgery, Fukushima Medical University, Fukushima, Japan.
Department of Diagnostic Pathology, Fukushima Medical University, Fukushima, Japan.
Case Rep Oncol. 2020 Nov 30;13(3):1387-1392. doi: 10.1159/000511112. eCollection 2020 Sep-Dec.
Large cell neuroendocrine carcinoma (LCNEC) of the lung with epidermal growth factor receptor () mutation is rare, and few cases have been treated with EGFR tyrosine kinase inhibitors (TKIs). We report the treatment of combined LCNEC with adenocarcinoma harboring an mutation with EGFR-TKIs and bevacizumab. Our patient was a 70-year-old asymptomatic woman who underwent surgical resection of the lung for combined LCNEC with adenocarcinoma harboring an activating mutation 11 months previously. Magnetic resonance imaging (MRI) and positron emission tomography revealed metastatic lesions in the brain and lung. The patient was diagnosed with recurrence of combined LCNEC with adenocarcinoma. The brain lesion was irradiated, followed by administration of afatinib. Eight months after irradiation, brain MRI revealed ringed enhancement and perilesional edema after radiotherapy without new metastatic lesions. We switched treatment to erlotinib and bevacizumab, resulting in maintenance of stable disease for 10 months. Overall, the disease was controlled for 18 months with EGFR-TKIs and bevacizumab. Combination treatment with EGFR-TKIs and bevacizumab could be a treatment option for LCNEC of the lung harboring mutations, especially with brain metastasis.
伴有表皮生长因子受体（EGFR）突变的肺大细胞神经内分泌癌（LCNEC）较为罕见，仅有少数病例接受过EGFR酪氨酸激酶抑制剂（TKIs）治疗。我们报告了1例合并EGFR突变腺癌的LCNEC患者接受EGFR-TKIs和贝伐单抗联合治疗的情况。我们的患者是一名70岁无症状女性，11个月前因合并EGFR激活突变的LCNEC与腺癌接受了肺手术切除。磁共振成像（MRI）和正电子发射断层扫描显示脑和肺有转移病灶。该患者被诊断为合并LCNEC与腺癌复发。对脑部病灶进行了放疗，随后给予阿法替尼。放疗8个月后，脑部MRI显示放疗后环形强化和病灶周围水肿，无新的转移病灶。我们将治疗改为厄洛替尼和贝伐单抗，疾病稳定维持了10个月。总体而言，使用EGFR-TKIs和贝伐单抗疾病得到控制达18个月。EGFR-TKIs和贝伐单抗联合治疗可能是伴有EGFR突变的肺LCNEC尤其是伴有脑转移患者的一种治疗选择。
