Department of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan.
Department of Respiratory Medicine, Japanese Red Cross Okayama Hospital, Okayama, Japan.
Thorac Cancer. 2021 Apr;12(8):1248-1251. doi: 10.1111/1759-7714.13897. Epub 2021 Mar 2.
In non-small cell lung cancer (NSCLC), uncommon epidermal growth factor receptor (EGFR) mutations are mutations other than Ex19 deletion and Ex21 L858R, which are common mutations highly sensitive to EGFR-tyrosine kinase inhibitors. Afatinib, a second-generation EGFR-tyrosine kinase inhibitor, has been shown to be effective in patients with uncommon mutations. Dacomitinib, another second-generation EGFR-tyrosine kinase inhibitor, has not previously been shown to be effective in patients with uncommon mutations. Here, we report the efficacy of dacomitinib for uncommon EGFR mutations in a 71-year-old woman diagnosed with metastatic lung adenocarcinoma with uncommon EGFR mutation (Ex18 G719A). Afatinib was administered as the first-line treatment, and a remarkable antitumor effect was observed. However, the tumor grew after 14 months. Pemetrexed plus carboplatin followed by pemetrexed, docetaxel, atezolizumab and S-1 were performed in sequence. Although approximately four years had passed since the start of treatment, her physical condition was good. The patient started dacomitinib as the sixth-line treatment. Lesions were markedly reduced and treatment with dacomitinib was continued for 7.8 months. Dacomitinib is a possible treatment option for NSCLC with uncommon mutations.
在非小细胞肺癌（NSCLC）中，罕见的表皮生长因子受体（EGFR）突变是除了常见突变 Ex19 缺失和 Ex21 L858R 之外的突变，这些常见突变对 EGFR-酪氨酸激酶抑制剂高度敏感。阿法替尼是一种第二代 EGFR-酪氨酸激酶抑制剂，已被证明对罕见突变的患者有效。达可替尼，另一种第二代 EGFR-酪氨酸激酶抑制剂，以前并未显示对罕见突变的患者有效。在这里，我们报告了一例 71 岁女性转移性肺腺癌罕见 EGFR 突变（Ex18 G719A）患者使用达可替尼的疗效。阿法替尼被用作一线治疗，观察到显著的抗肿瘤作用。然而，肿瘤在 14 个月后生长。随后序贯给予培美曲塞加卡铂联合培美曲塞、多西他赛、阿替利珠单抗和 S-1。尽管自开始治疗以来已经过去了大约四年，但患者的身体状况良好。患者开始使用达可替尼作为第六线治疗。病灶明显减少，继续使用达可替尼治疗 7.8 个月。达可替尼可能是治疗罕见突变型 NSCLC 的一种选择。
