Wan Yuming, Xu Feng, Wang Jin
Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Lung Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Transl Cancer Res. 2022 Dec;11(12):4448-4454. doi: 10.21037/tcr-22-1671.
Lung cancer is the leading cause of cancer-related death worldwide. Up to 85% of lung cancer is non-small cell lung cancer (NSCLC) and most patients present with advanced disease at first diagnosis. Targeted therapy plays an important role in the treatment of advanced NSCLC. Epidermal growth factor receptor () mutation is a predictive marker of sensitivity to tyrosine kinase inhibitors (TKIs). Patients with -mutated NSCLC are prone to developing central nervous system (CNS) metastasis and poor prognosis (4-6 months). Brain metastases (BMs) remain a tricky problem in NSCLC patients and impose a distinct challenge for clinicians.
This article details a patient with -mutated BMs accepting a series of treatments but without chemotherapy, resulting in significantly prolonged survival with overall survival (OS) over 8 years and improved clinical symptoms. The patient in our case received four lines of treatments and the progression-free survival (PFS) in each line were longer than the previously reported without exception. It is worth noting that the combination of osimertinib and bevacizumab used in the fourth-line therapy has a PFS of 31 months and has not progressed so far.
Our case demonstrates that it is possible to achieve long-term survival in advanced -mutated NSCLC with multiple BMs and systemic progression through a reasonable therapeutic schedule.
肺癌是全球癌症相关死亡的主要原因。高达85%的肺癌是非小细胞肺癌（NSCLC），大多数患者在初次诊断时就已处于晚期。靶向治疗在晚期NSCLC的治疗中起着重要作用。表皮生长因子受体（）突变是对酪氨酸激酶抑制剂（TKIs）敏感性的预测标志物。携带突变的NSCLC患者易发生中枢神经系统（CNS）转移且预后较差（4 - 6个月）。脑转移（BMs）在NSCLC患者中仍然是一个棘手的问题，给临床医生带来了独特的挑战。
本文详细介绍了一名携带突变的BMs患者接受了一系列治疗但未进行化疗，从而显著延长了生存期，总生存期（OS）超过8年且临床症状得到改善。我们病例中的患者接受了四线治疗，且每一线的无进展生存期（PFS）均无一例外地长于先前报道。值得注意的是，四线治疗中使用的奥希替尼和贝伐单抗联合方案的PFS为31个月，且至今未进展。
我们的病例表明，通过合理的治疗方案，晚期携带突变且有多处BMs和全身进展的NSCLC患者有可能实现长期生存。
