Department of Oncology.
Department of Pulmonary Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Medicine (Baltimore). 2021 Jan 29;100(4):e24300. doi: 10.1097/MD.0000000000024300.
Lung cancer is a leading cause of cancer-related mortality worldwide. Currently, targeted therapy has proved highly efficient in the treatment of advanced non-small cell lung cancer (NSCLC). Mesenchymal-epithelial transition factor (MET) is considered a validated molecular target in NSCLC. Given the low incidence of MET exon 14 skipping mutation, the planning of precision treatment for patients is a clinical problem that needs to be solved. In this report, we present a MET-positive case that benefited from crizotinib and cabozantinib treatment.
A 77-year-old patient was diagnosed with lung adenocarcinoma in our hospital. Positron emission tomography-computed tomography (PET-CT) showed a right upper lobe mass (58 × 56 mm, SUVmax 15.6), right hilar enlarged lymph nodes, and multiple bone and left adrenal metastases (c-T3N1M1c).
MET exon 14 mutation (exon14, c.2888-1G>C) was examined using the lung puncture sample by next generation sequencing. Therefore, the patient was diagnosed with late-stage lung adenocarcinoma with MET exon14 skipping gene mutation.
Crizotinib was given as the first-line treatment from August 2019. Considering the resistance of crizotinib, cabozantinib was given for second-line treatment.
Crizotinib was administered (250 mg bid) for 8 months, and her disease achieved partial regression (PR) and progression-free survival (PFS), which lasted for 8 months. The patient also reached PR after the second-line treatment with cabozantinib, and is currently under follow-up, with an overall survival (OS) of >12 months.
As MET exon 14 skipping mutation is rare in clinical practices, MET-TKIs (tyrosine kinase inhibitors) treatment can boost curative effects and improve prognosis of patients with advanced lung adenocarcinoma. This case report supports a rationale for the treatment of lung adenocarcinoma patients with a MET exon 14 skipping mutation and provides alternative treatment options for these types of NSCLC patients.
肺癌是全球癌症相关死亡的主要原因。目前，靶向治疗已被证明在治疗晚期非小细胞肺癌（NSCLC）方面非常有效。间质上皮转化因子（MET）被认为是 NSCLC 的一个经过验证的分子靶点。鉴于 MET 外显子 14 跳跃突变的发生率较低，规划患者的精准治疗是一个需要解决的临床问题。在本报告中，我们报告了一例 MET 阳性患者，该患者从克唑替尼和卡博替尼治疗中获益。
一名 77 岁患者在我院被诊断为肺腺癌。正电子发射断层扫描-计算机断层扫描（PET-CT）显示右上肺肿块（58×56mm，SUVmax 15.6），右肺门淋巴结肿大，以及多处骨和左肾上腺转移（c-T3N1M1c）。
通过肺部穿刺样本进行下一代测序检查到 MET 外显子 14 突变（exon14，c.2888-1G>C）。因此，患者被诊断为晚期肺腺癌合并 MET 外显子 14 跳跃基因突变。
从 2019 年 8 月开始，给予克唑替尼作为一线治疗。考虑到克唑替尼的耐药性，给予卡博替尼作为二线治疗。
患者接受克唑替尼（bid 250mg）治疗 8 个月，疾病达到部分缓解（PR）和无进展生存期（PFS），持续 8 个月。二线治疗用卡博替尼后，患者也达到 PR，目前正在随访中，总生存期（OS）>12 个月。
由于 MET 外显子 14 跳跃突变在临床上较为罕见，MET-TKIs（酪氨酸激酶抑制剂）治疗可提高晚期肺腺癌患者的疗效并改善预后。本病例报告支持对 MET 外显子 14 跳跃突变的肺腺癌患者进行治疗，并为这些类型的 NSCLC 患者提供了替代治疗方案。
