Yang Xiaojuan, Qin Diyuan, Zhang Yu, Li Xue, Liu Ning, Zhou Ying, Feng Ming, Wang Yongsheng
Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, China.
State Key Laboratory of Biotherapy, Sichuan University, No. 17, Section 3, Renmin South Road, Chengdu 610041, China.
Precis Clin Med. 2019 Oct;2(3):197-203. doi: 10.1093/pcmedi/pbz013. Epub 2019 Aug 28.
We report the case of a 90-year-old female patient who was suffering from c-ros oncogene 1 () rearrangement adenocarcinoma and breast cancer. After about 14 months of a reduced dose of crizotinib treatment, she had a stable disease according to the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1). This patient's case demonstrates that rearrangements are not limited to patients of young age. In addition, this case indicates that crizotinib, as second-line, or even first-line, treatment may be effective and manageable in elderly patients. Furthermore, for elderly patients carrying a fusion, a reduced dose of crizotinib may be efficacious rather than a resistance factor. Based on our findings, we recommend that elderly patients with advanced lung adenocarcinoma should be considered for inclusion in molecular screening for translocation, especially for never-smokers negative for epidermal growth factor receptor () mutation and the fusion between echinoderm microtubule associated protein-like 4 (EML4) and anaplastic lymphoma kinase (ALK). This deserves attention because the population is aging, with increasing incidence and morbidity of multiple primary malignant tumors. Neglect of breast nodules at the onset is one of the limitations of our case, as combination of primary lung cancer with breast cancer is common. Above all, use of antiestrogens before and after the diagnosis of non-small-cell lung cancer is related to a reduced risk of lung cancer mortality. Therefore, careful attention should always be paid to these cases.
我们报告了一例90岁女性患者，她患有c-ros原癌基因1（）重排腺癌和乳腺癌。在接受约14个月的克唑替尼减量治疗后，根据实体瘤疗效评价标准1.1版（RECIST 1.1），她的病情稳定。该患者的病例表明，重排并不局限于年轻患者。此外，该病例表明，克唑替尼作为二线甚至一线治疗，在老年患者中可能有效且易于管理。此外，对于携带融合的老年患者，克唑替尼减量可能有效而非耐药因素。基于我们的研究结果，我们建议对晚期肺腺癌老年患者进行分子筛查，以检测易位，特别是对于表皮生长因子受体（）突变阴性且棘皮动物微管相关蛋白样4（EML4）与间变性淋巴瘤激酶（ALK）融合阴性的从不吸烟者。这一点值得关注，因为人口正在老龄化，多种原发性恶性肿瘤的发病率和患病率不断上升。发病时忽视乳腺结节是我们病例的局限性之一，因为原发性肺癌合并乳腺癌很常见。最重要的是，在非小细胞肺癌诊断前后使用抗雌激素与降低肺癌死亡率风险有关。因此，应对这些病例始终予以密切关注。
