Feng Shao, Qiang Zhang, Wanwan Cheng, Zhaozhun Zeng, Yuewu Xie, Shencun Fang
Department of Thoracic Surgery, Nanjing Chest Hospital, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
Department of Respiratory Medicine, Nanjing Chest Hospital, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
Front Oncol. 2022 Mar 29;12:872225. doi: 10.3389/fonc.2022.872225. eCollection 2022.
There is no standard treatment for stage III lung cancer due to its low surgical resection rate, and improving PFS and survival of patients with III NSCLC has become an urgent challenge in clinical treatment. For EGFR mutation-positive patients, targeted therapy has the remarkable feature of high efficiency and low toxicity compared with first-line standard chemotherapy, and targeted neoadjuvant therapy needs to be further explored.
We report 3 diagnosed cases of locally advanced unresectable NSCLC with EGFR-sensitive mutations who first received 1-2 cycles of preoperative chemotherapy neoadjuvant therapy and were treated with 110 mg daily of 3rd-generation EGFR-TKI aumolertinib instead because of poor efficacy or safety intolerance.
After 2 cycles of aumolertinib treatment, all 3 patients achieved symptomatic remission and significant tumor size reduction and achieved downstaging to allow surgical treatment. No additional operative difficulties were added during the surgery. They continued to receive adjuvant therapy with the original dose of aumolertinib after surgical treatment, and no evidence of tumor recurrence was found until the most recent imaging examination. In addition, the course of neoadjuvant and adjuvant therapy was free of serious adverse effects.
Perioperative treatment of these three cases of locally advanced unresectable NSCLC with EGFR-sensitive mutations with the third-generation EGFR-TKI aumolertinib showed significant efficacy and excellent safety and may be a new option for targeted therapy in the perioperative period.
Ⅲ期肺癌手术切除率低，尚无标准治疗方案，提高Ⅲ期非小细胞肺癌（NSCLC）患者的无进展生存期（PFS）和生存率已成为临床治疗中的紧迫挑战。对于表皮生长因子受体（EGFR）突变阳性患者，与一线标准化疗相比，靶向治疗具有高效低毒的显著特点，靶向新辅助治疗有待进一步探索。
我们报告3例诊断为局部晚期不可切除NSCLC且伴有EGFR敏感突变的病例，这些患者首先接受了1 - 2周期的术前化疗新辅助治疗，但因疗效不佳或安全性不耐受，改为每日服用110 mg第三代EGFR酪氨酸激酶抑制剂（TKI）奥莫替尼进行治疗。
经过2周期奥莫替尼治疗，所有3例患者均实现症状缓解且肿瘤大小显著缩小，分期降低从而得以进行手术治疗。手术期间未增加额外的手术困难。术后他们继续接受原剂量奥莫替尼辅助治疗，直至最近一次影像学检查均未发现肿瘤复发迹象。此外，新辅助和辅助治疗过程中均未出现严重不良反应。
采用第三代EGFR - TKI奥莫替尼对这3例局部晚期不可切除且伴有EGFR敏感突变的NSCLC患者进行围手术期治疗，疗效显著且安全性良好，可能成为围手术期靶向治疗的新选择。
