Shan Xiu, Wu Yuanhang, Liu Jiwei
Department of Oncology, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Transl Cancer Res. 2023 Feb 28;12(2):434-438. doi: 10.21037/tcr-22-1614. Epub 2023 Feb 1.
Brain metastases happen in approximately 70% of epidermal growth factor receptor ()-mutant non-small cell lung cancer (NSCLC) patients. It negatively impacts the survival and quality of life, with the median survival time for untreated patients is just 2.9 months. Nevertheless, no extensive research data is available for symptomatic brain metastases because asymptomatic brain metastases patients are usually included in the clinical trials then.
Here, we report a 74-year-old male lung cancer patient with symptomatic brain metastases and performance status (PS) score of ~4. The patient was presented to our clinic on July 19 2020 with dizziness for one day, convulsions in the right lower limb for 2 hours, nausea, and severe vomiting. Further tissue and imaging analysis revealed -mutant stage IV (cT2N3M1) NSCLC with multiple brain metastases and cerebral edema. Initially, he was treated with bevacizumab on July 24 for one cycle, then with novel third-generation EGFR-tyrosine kinase inhibitor (TKI) aumolertinib at 110 mg daily from July 31 until disease control. Systemic partial remission (PR) and complete intracranial remission had been achieved in the lung and intracranial lesions. Notably, the PS score has detected as a level 4 at the time of diagnosis. After 2 weeks of aumolertinib administration, the patient showed significant improvement, and the PS score returned to 0. Interestingly, the patient significantly recovered from brain metastases and living a healthy daily life; nevertheless, he is currently receiving aumolertinib monotherapy for NSCLC and being follow-up for clinical updates.
Our case presented a patient with -mutant NSCLC with symptomatic brain metastases. Aumolertinib proved to be a highly effective and well-tolerated treatment option for sustained disease control and comprehensive future studies are needed to confirm its efficacy in a larger population.
脑转移发生在大约70%的表皮生长因子受体（EGFR）突变的非小细胞肺癌（NSCLC）患者中。它对生存和生活质量产生负面影响，未经治疗的患者中位生存时间仅为2.9个月。然而，由于无症状脑转移患者通常被纳入临床试验，因此关于有症状脑转移的广泛研究数据并不存在。
在此，我们报告一名74岁男性肺癌患者，有症状性脑转移，体能状态（PS）评分为~4。该患者于2020年7月19日因头晕1天、右下肢抽搐2小时、恶心和严重呕吐就诊于我们的诊所。进一步的组织和影像学分析显示为EGFR突变的IV期（cT2N3M1）NSCLC伴多发脑转移和脑水肿。最初，他于7月24日接受了1个周期的贝伐单抗治疗，然后从7月31日起每天服用110mg新型第三代EGFR酪氨酸激酶抑制剂（TKI）奥莫替尼直至疾病得到控制。肺部和颅内病变均实现了全身部分缓解（PR）和颅内完全缓解。值得注意的是，诊断时PS评分为4级。奥莫替尼给药2周后，患者显示出明显改善，PS评分恢复到0。有趣的是，患者从脑转移中显著康复并过上了健康的日常生活；然而，他目前正在接受奥莫替尼单药治疗NSCLC，并正在接受临床随访以了解最新情况。
我们的病例展示了一名有症状性脑转移的EGFR突变NSCLC患者。奥莫替尼被证明是一种高效且耐受性良好的治疗选择，可实现持续的疾病控制，需要进行全面的未来研究以确认其在更大人群中的疗效。
