Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.
Medicine (Baltimore). 2022 Dec 9;101(49):e31875. doi: 10.1097/MD.0000000000031875.
Epidermal growth factor receptor (EGFR) T854A mutation in exon 21 is an uncommon EGFR mutation in patients with non-small cell lung cancer (NSCLC). It is a secondary EGFR mutation after first- and second-generation EGFR tyrosine kinase inhibitors (TKIs). All EGFR T854A mutations were co-occurred with EGFR L858R mutation in cis. There is still no clear evidence to guide the therapeutic options for patients with both EGFR T790M and T854A mutations.
A 60-year-old Chinese woman with no smoking history presented with a maximum diameter of 32.9 mm mass located in the right lower lung lobe.
The patient was diagnosed with stage IVA lung adenocarcinoma with an exceptionally uncommon EGFR T854A mutation in exon 21 was detected concomitantly with EGFR T790M in blood by next-generation sequencing (NGS).
The patient was initially treated with first-line afatinib. After disease progression, osimertinib was administered.
Our patient exhibited a partial response (PR) to osimertinib with progression-free survival of nearly 8 months.
Our study indicates that patients with NSCLC who are positive for uncommon EGFR T854A and T790M mutations might benefit from treatment with osimertinib.
表皮生长因子受体（EGFR）第 21 外显子 T854A 突变是一种非小细胞肺癌（NSCLC）患者中罕见的 EGFR 突变。它是第一代和第二代 EGFR 酪氨酸激酶抑制剂（TKI）治疗后的继发 EGFR 突变。所有的 EGFR T854A 突变均与 EGFR L858R 突变共位发生。对于同时存在 EGFR T790M 和 T854A 突变的患者，目前仍没有明确的证据来指导治疗选择。
一位 60 岁的中国女性，无吸烟史，右肺下叶有一个最大直径为 32.9mm 的肿块。
患者被诊断为 IVA 期肺腺癌，通过下一代测序（NGS）在血液中同时检测到罕见的 EGFR T854A 突变（第 21 外显子）和 EGFR T790M。
患者最初接受一线阿法替尼治疗。疾病进展后，给予奥希替尼治疗。
我们的患者对奥希替尼表现出部分缓解（PR），无进展生存期近 8 个月。
我们的研究表明，同时存在罕见的 EGFR T854A 和 T790M 突变的 NSCLC 患者可能受益于奥希替尼治疗。
