Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
Medicine (Baltimore). 2023 Aug 25;102(34):e34545. doi: 10.1097/MD.0000000000034545.
With the advancement of targeted therapies, epidermal growth factor receptor tyrosine kinase inhibitors have become the preferred initial treatment for patients with advanced epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer. Osimertinib, a third-generation epidermal growth factor receptor tyrosine kinase inhibitor, is effective against exon 19 and 21 mutations as well as the T790M mutation. It has been approved by both the food and drug administration and European Medicines Agency for the treatment of non-small cell lung cancer patients with locally advanced or metastatic EGFR-mutated tumors, including those who have acquired T790M mutations.
To evaluate the effectiveness of osimertinib in treating patients with EGFR-mutated advanced lung adenocarcinoma and bone metastases, we present the treatment outcomes of 3 patients with EGFR 19 deletion-mutated advanced lung adenocarcinoma and bone metastases who received osimertinib treatment in recent years. All 3 cases involved elderly female patients, aged 62, 62, and 54, respectively.
All 3 cases exhibited a diagnosis of pulmonary adenocarcinoma accompanied by osseous metastases, with genetic testing revealing the presence of an EGFR 19del mutation.
In the first case, following 17 months of gefitinib therapy, disease progression prompted a switch to osimertinib treatment. In the second case, bone metastases were detected after 20 months of pemetrexed-carboplatin chemotherapy, leading to a transition to osimertinib therapy. In the third case, after 11 months of erlotinib treatment, bone metastases were identified. Subsequent interventions, including radiation therapy, pemetrexed-carboplatin chemotherapy, pemetrexed-bevacizumab maintenance therapy, and docetaxel chemotherapy, failed to arrest the progression of bone metastases. As a result, a combination of osimertinib and anlotinib targeted therapy was administered.
All 3 patients experienced relatively good and favorable survival outcomes, with a progression-free survival of 22.7 months, 12 months, and 17.7 months, respectively.
These cases suggest that osimertinib is a promising treatment option for patients with EGFR 19 deletion-mutated lung adenocarcinoma and bone metastases, although further clinical studies are needed to confirm its efficacy.
随着靶向治疗的进步，表皮生长因子受体酪氨酸激酶抑制剂已成为晚期表皮生长因子受体（EGFR）突变型非小细胞肺癌患者的首选初始治疗方法。奥希替尼是一种第三代表皮生长因子受体酪氨酸激酶抑制剂，对exon 19 和 21 突变以及 T790M 突变均有效。它已被美国食品和药物管理局和欧洲药品管理局批准用于治疗局部晚期或转移性 EGFR 突变肿瘤的非小细胞肺癌患者，包括已获得 T790M 突变的患者。
为评估奥希替尼治疗 EGFR 突变型晚期肺腺癌和骨转移患者的疗效，我们报告了 3 例 EGFR 19 缺失突变型晚期肺腺癌和骨转移患者接受奥希替尼治疗的结果。所有 3 例均为老年女性，年龄分别为 62、62 和 54 岁。
所有 3 例均诊断为肺腺癌伴骨转移，基因检测显示存在 EGFR 19del 突变。
在第 1 例中，在接受吉非替尼治疗 17 个月后，疾病进展促使改用奥希替尼治疗。在第 2 例中，在培美曲塞-卡铂化疗 20 个月后发现骨转移，继而改用奥希替尼治疗。在第 3 例中，在接受厄洛替尼治疗 11 个月后，发现骨转移。随后的干预措施，包括放疗、培美曲塞-卡铂化疗、培美曲塞-贝伐单抗维持治疗和多西他赛化疗，均未能阻止骨转移的进展。因此，给予奥希替尼和安罗替尼联合靶向治疗。
所有 3 例患者的生存结局均相对较好，无进展生存期分别为 22.7 个月、12 个月和 17.7 个月。
这些病例表明，奥希替尼是 EGFR 19 缺失突变型肺腺癌和骨转移患者的一种有前途的治疗选择，尽管需要进一步的临床研究来证实其疗效。
