Zhao Tong, Tian Yuqin, Ding Xinjia, Liu Lin, Tan Bowen, Yang Bin, Wu Jianlin, Lei Ting, Wang Ruoyu, Ding Yan
Department of Oncology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, People's Republic of China.
Department of Care Operations, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China.
Onco Targets Ther. 2021 Apr 28;14:2839-2845. doi: 10.2147/OTT.S298697. eCollection 2021.
Multiple primary cancers (MPC) occurring in the same individual is considered rare but being increasingly recognized owing to the longer cancer survival nowadays. Despite of accumulating experience in diagnosis, effective treatment remains to be problematic in many scenarios. Genetic testing-based targeted therapy could be an invaluable option for both diagnosis and treatment of such patients. Here we present a 74-year-old male with triple primary cancers including kidney, prostate, and lung with metastatic tumor on the costal bones. The patient visited the hospital for persistent cough and hemoptysis, and a diagnosis of squamous cell carcinoma of the left lung was made by bioptic fiberoptic bronchoscopy. A previous history included renal cancer controlled by Sorafenib and prostate cancer controlled by Goserelin. Radiotherapy and platinum-based chemotherapy failed to help the patient and the tumor size increased over a period of 6 months. In order to seek better therapeutical options, we performed targeted sequencing using the cancerous tissues from his lung, kidney, and prostate cancers. Briefly, the results identified VHL, EGFR, PIK3CA, TP53, and AKT1 mutations in lung cancer, AKT1, FGFR2, and TP53 mutations in renal cancer, and FGFR2 mutations in prostate cancer. A combined medication targeting PIK3CA and AKT1 signaling was recommended and the patient was given BKM120 (PIK3CA, Phase III clinical trial) and MK2206 (AKT, phase III clinical trial). Revisit chest CTs after 4 months and 9 months showed a significant shrinkage of tumor size by 40% and 80%, respectively. Our experience demonstrated a good example that genetic analysis could be valuable to diagnose and precisely treat multiple primary cancers.
同一个体发生多种原发性癌症（MPC）被认为较为罕见，但由于如今癌症患者生存期延长，这种情况越来越受到关注。尽管在诊断方面积累了经验，但在许多情况下，有效的治疗仍然存在问题。基于基因检测的靶向治疗可能是此类患者诊断和治疗的宝贵选择。在此，我们报告一名74岁男性，患有三种原发性癌症，包括肾癌、前列腺癌和肺癌，且肋骨有转移瘤。患者因持续咳嗽和咯血就诊，经纤维支气管镜活检诊断为左肺鳞状细胞癌。既往史包括曾用索拉非尼控制的肾癌和用戈舍瑞林控制的前列腺癌。放疗和铂类化疗均未能使患者病情好转，且肿瘤大小在6个月内增大。为寻求更好的治疗方案，我们对其肺癌、肾癌和前列腺癌的癌组织进行了靶向测序。简要来说，结果在肺癌中鉴定出VHL、EGFR、PIK3CA、TP53和AKT1突变，在肾癌中鉴定出AKT1、FGFR2和TP53突变，在前列腺癌中鉴定出FGFR2突变。建议联合使用针对PIK3CA和AKT1信号通路的药物，给予患者BKM120（PIK3CA，III期临床试验药物）和MK2206（AKT，III期临床试验药物）。4个月和9个月后复查胸部CT显示，肿瘤大小分别显著缩小了40%和80%。我们的经验证明了一个很好的例子，即基因分析对于诊断和精确治疗多种原发性癌症可能具有重要价值。
