Department of Medical Oncology, Affiliated Hospital of Hebei University, Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Baoding, China.
Burning Rock Biotech, Guangzhou, China.
Ann Palliat Med. 2022 Mar;11(3):1126-1134. doi: 10.21037/apm-21-3731.
Osimertinib, as a third-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI), targeting EGFR exon 19 deletions, L858R, and T790M, has shown robust clinical efficacy and promising survival advantages in a subset of non-small cell lung cancer (NSCLC) patients. However, osimertinib-treated patients ultimately develop secondary resistance. Besides EGFR C797S mutation and EGFR amplification, a rare EGFR mutation, L718V, has been reported to confer osimertinib resistance in the literature, which is developed in about 8.0% of osimertinib-resistant NSCLC patients. Although the National Comprehensive Cancer Network or Chinese Society of Clinical Oncology NSCLC guidelines recommend radiotherapy, anti-angiogenesis therapy, chemotherapy and or immunotherapy for the treatment of NSCLC patients who acquire resistance to osimertinib, the feasible treatment options for patients harboring EGFR L718V remain elusive. There is an unmet need to develop effective strategies to treat EGFR L718X-positive NSCLC patients. Herein, we report that a lung adenocarcinoma patient with acquired EGFR L718V mutation-mediated resistance towards osimertinib derived durable response to the second-generation EGFR-TKI afatinib with a progression-free survival of 18 months and counting. Our work provides clinical evidence to administer afatinib in metastatic NSCLC patients who develop EGFR L718V at progression to osimertinib and paves the way for its potential clinical utilization.
奥希替尼作为第三代表皮生长因子受体(EGFR)-酪氨酸激酶抑制剂(TKI),针对 EGFR 外显子 19 缺失、L858R 和 T790M,在非小细胞肺癌(NSCLC)患者亚组中显示出强大的临床疗效和有前途的生存优势。然而,奥希替尼治疗的患者最终会产生继发耐药。除了 EGFR C797S 突变和 EGFR 扩增外,文献中还报道了一种罕见的 EGFR 突变 L718V,它可导致奥希替尼耐药,约 8.0%的奥希替尼耐药 NSCLC 患者发生这种突变。尽管美国国家综合癌症网络或中国临床肿瘤学会 NSCLC 指南建议对获得奥希替尼耐药的 NSCLC 患者进行放疗、抗血管生成治疗、化疗和/或免疫治疗,但对于携带 EGFR L718V 的患者,可行的治疗选择仍难以捉摸。需要开发有效的策略来治疗 EGFR L718X 阳性 NSCLC 患者。在此,我们报告了一例肺腺癌患者,其获得性 EGFR L718V 突变介导的奥希替尼耐药对第二代 EGFR-TKI 阿法替尼产生持久反应,无进展生存期为 18 个月,且仍在持续。我们的工作为进展期奥希替尼获得 EGFR L718V 的转移性 NSCLC 患者使用阿法替尼提供了临床证据,并为其潜在的临床应用铺平了道路。