Wang Hongming, Wu Zhijun, Du Yangfeng, Wu Tao, Tian Wei, Dong Wen, Cai Juan, Zheng Jiang, Zhang Yan, Li Shiyan, Xu Wei, Qin Jing, Xiao Zemin
Department of Oncology, The First People's Hospital of Changde City, Changde, China.
Department of Thoracic Surgery, The First People's Hospital of Changde City, Changde, China.
Front Oncol. 2023 Mar 10;13:1145021. doi: 10.3389/fonc.2023.1145021. eCollection 2023.
Epidermal growth factor receptor (EGFR) mutations have been frequently detected in patients with pulmonary adenocarcinoma. EGFR Exon 19Del and 21L858R mutations are the two most common EGFR mutations. EGFR-tyrosine kinase inhibitors (TKIs) are widely employed to treat patients with non-small cell lung cancer (NSCLC) harboring EGFR mutations. Recently, there has been rapid growth in clinical trials assessing neoadjuvant targeted therapy, indicating good application prospects owing to high efficiency and low toxicity. Herein, we discuss the case of a 56-year-old male patient who was initially diagnosed with stage IIIA pulmonary adenocarcinoma (AJCC,8 edition) of the left lower lung with an EGFR Exon 19Del mutation. The patient was treated with osimertinib but failed to undergo timely review and surgery. Subsequently, the patient underwent two cycles of neoadjuvant chemotherapy (NAC) combined with neoadjuvant targeted therapy. After the tumor load and size had significantly decreased, radical surgery was successfully performed under thoracoscopy. However, postoperative pathology revealed carcinosarcoma, pT2aN0M0, stage IB, and the pathological response was 50%. The present case report provides practical clinical evidence for the application of neoadjuvant targeted therapy combined with chemotherapy for locally advanced primary pulmonary carcinosarcoma with EGFR mutation.
表皮生长因子受体（EGFR）突变在肺腺癌患者中经常被检测到。EGFR外显子19缺失和21L858R突变是两种最常见的EGFR突变。EGFR酪氨酸激酶抑制剂（TKIs）被广泛用于治疗携带EGFR突变的非小细胞肺癌（NSCLC）患者。最近，评估新辅助靶向治疗的临床试验迅速增加，因其高效和低毒而显示出良好的应用前景。在此，我们讨论一例56岁男性患者，最初被诊断为左下肺IIIA期肺腺癌（AJCC第8版），伴有EGFR外显子19缺失突变。该患者接受了奥希替尼治疗，但未及时复查和手术。随后，患者接受了两个周期的新辅助化疗（NAC）联合新辅助靶向治疗。在肿瘤负荷和大小显著降低后，成功在胸腔镜下进行了根治性手术。然而，术后病理显示为癌肉瘤，pT2aN0M0，IB期，病理反应为50%。本病例报告为EGFR突变的局部晚期原发性肺肉瘤样癌应用新辅助靶向治疗联合化疗提供了实际临床证据。
