Medical School, Kunming University of Science and Technology, The First People's Hospital of Yunnan Province, Kunming, China.
Department of Medical Oncology, The First People's Hospital of Yunnan Province, Kunming, China.
Medicine (Baltimore). 2023 Jan 27;102(4):e32697. doi: 10.1097/MD.0000000000032697.
Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs) are commonly used in the treatment of advanced non-small cell lung cancer. However, patients will inevitably develop resistance to EGFR-TKIs in the long-term treatment process. In this paper, we report a case of small cell lung cancer transformation after EGFR-TKIs treatment in lung adenocarcinoma. We summarize the characteristics of this case and the treatment after transformation, and emphasized the repeat biopsy and dynamic monitoring its genetic mutation was necessary.
A 75-years-old man with no smoking history was admitted to our hospital with repeated cough and expectoration for 1 month and chest enhancement computed tomography showed paracbronchial soft tissue mass in the lower lobe of the left lung, which was considered to be central lung cancer.
The first pathological analysis of lung biopsy confirmed left lung adenocarcinoma and clinical stage was T3N3M1 IVA. In June 2021, the second bronchoscopic biopsy was performed, and pathology showed small cell neuroendocrine carcinoma in the left lung.
Gefitinib was given to patients when the first next generation sequence test showed EGFR L858 mutation. When the second next generation sequence test revealed EGFR T790M mutation, the patient received with osimertinib. The patient got 2 cycles chemotherapy of etoposide plus netaplatin when diagnosed with small cell lung cancer.
Progression-free survival was only 8 months after gefitinib treatment. Moreover, the patient was insensitive to Oxitinib, and the disease progressed after 2 months of treatment with Oxitinib. Finally, he died of severe infection and hepatic failure after a diagnosis of small cell lung cancer.
Our case highlights that if a patient has rapid disease progression, increase of serum neuron-specific enolase, and TP53 and Rb1 inactivation during EGFR-TKIs treatment, we should be alert to the pathological type transformation to small cell lung cancer.
表皮生长因子受体酪氨酸激酶抑制剂（EGFR-TKIs）常用于治疗晚期非小细胞肺癌。然而，患者在长期治疗过程中不可避免地会对 EGFR-TKIs 产生耐药性。本文报道了一例 EGFR-TKIs 治疗肺腺癌后发生小细胞肺癌转化的病例。我们总结了该病例的特点及转化后的治疗，并强调了重复活检和动态监测其基因突变的必要性。
一名 75 岁男性，无吸烟史，因反复咳嗽、咳痰 1 个月就诊。胸部增强 CT 显示左下肺支气管旁软组织肿块，考虑为中央型肺癌。
第一次病理分析活检证实为左肺腺癌，临床分期为 T3N3M1 IVA 期。2021 年 6 月，行第二次支气管镜活检，病理显示左肺癌为小细胞神经内分泌癌。
第一次下一代测序检测显示 EGFR L858 突变后，给予患者吉非替尼治疗。第二次下一代测序检测发现 EGFR T790M 突变后，患者接受奥希替尼治疗。当诊断为小细胞肺癌时，患者接受了 2 个周期依托泊苷加奈达铂的化疗。
吉非替尼治疗后无进展生存期仅为 8 个月。而且，患者对奥昔替尼不敏感，奥昔替尼治疗 2 个月后疾病进展。最终，患者被诊断为小细胞肺癌后，因严重感染和肝衰竭而死亡。
我们的病例强调，如果患者在 EGFR-TKIs 治疗过程中出现疾病快速进展、血清神经元特异性烯醇化酶升高、TP53 和 Rb1 失活等情况，应警惕病理类型向小细胞肺癌转化。
