Department of Respiratory and Critical Care, First Affiliated Hospital of Gannan Medical University.
Cyberspace Institute of Advanced Technology, Guangzhou University.
Anticancer Drugs. 2023 Sep 1;34(8):954-961. doi: 10.1097/CAD.0000000000001496. Epub 2023 Jan 4.
The development of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) represents a paradigm shift in the treatment of lung cancer with EGFR mutations. Aumolertinib has been shown to be a safe agent in the registry study. However, successful rechallenge with aumolertinib following osimertinib-induced myocardial damage has not been reported. In this article, a case of neoadjuvant therapy for lung adenocarcinoma is retrospectively analyzed, and the relevant literature is reviewed. The patient was diagnosed with stage IIIA lung adenocarcinoma, and genetic testing revealed EGFR exon 19 deletion mutation combined with Tumor Protein p53 (TP53) mutation. The mutation abundance is 33.5 and 14%, respectively. One month after osimertinib treatment, the patient developed myocardial damage, and abnormal indicators such as myocardial enzyme spectrum showed abnormalities and cardiac insufficiency, followed by pulmonary hypertension and pulmonary edema. Aumolertinib was subsequently used for treatment, following which the myocardial enzyme spectrum returned to normal, and the symptoms of bilateral interstitial edema disappeared. In addition to the disappearance of adverse reactions, the therapeutic effect was excellent; the lung lesions and mediastinal lymph nodes were significantly reduced, and the operation was successfully conducted. This is the first report of successful neoadjuvant treatment of EGFR exon 19 deletion combined with TP53 mutation in NSCLC using aumolertinib after osimertinib-induced myocardial damage. The results suggested that aumolertinib had fewer adverse reactions in patients with EGFR exon 19 deletion combined with TP53 mutation, and aumolertinib may be a potential neoadjuvant therapy for stage IIIA lung cancer.
表皮生长因子受体（EGFR）-酪氨酸激酶抑制剂（TKIs）的发展代表了治疗具有 EGFR 突变的肺癌的治疗模式的转变。奥莫替尼在注册研究中已被证明是一种安全的药物。然而，在奥莫替尼引起心肌损伤后成功重新使用奥莫替尼进行再挑战尚未报道。本文回顾性分析了一例肺腺癌新辅助治疗的病例，并复习了相关文献。患者被诊断为 IIIA 期肺腺癌，基因检测显示 EGFR 外显子 19 缺失突变合并肿瘤蛋白 p53（TP53）突变。突变丰度分别为 33.5%和 14%。奥西替尼治疗 1 个月后，患者出现心肌损伤，心肌酶谱等异常指标出现异常和心功能不全，随后出现肺动脉高压和肺水肿。随后使用奥莫替尼进行治疗，心肌酶谱恢复正常，双侧间质性水肿症状消失。除不良反应消失外，疗效极佳；肺部病变和纵隔淋巴结明显缩小，手术成功进行。这是首例报道奥莫替尼治疗奥西替尼引起心肌损伤后 EGFR 外显子 19 缺失合并 TP53 突变的非小细胞肺癌新辅助治疗成功的病例。结果表明，奥莫替尼在 EGFR 外显子 19 缺失合并 TP53 突变的患者中不良反应较少，奥莫替尼可能是 IIIA 期肺癌的一种潜在新辅助治疗药物。
