Deng Rui, Li Yan-Ying, Bai Liang-Liang, Zhou Li, Wang Yong-Sheng
Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Radiotherapy Physics & Technology, West China Hospital, Sichuan University, Chengdu, China.
Front Oncol. 2024 Aug 13;14:1450855. doi: 10.3389/fonc.2024.1450855. eCollection 2024.
The distant metastasis of lung cancer primarily occurs in the bones, liver, brain, and lungs, while the breast is an extremely rare site of metastasis. There is very limited literature on the occurrence of breast metastasis from lung cancer, and metastatic lesions in the breast are prone to being misdiagnosed as primary breast cancer, requiring careful attention and differentiation in the clinical diagnostic and treatment process.
The patient, a 63-year-old female, initially presented with an exon 21 L858R mutated left lung adenocarcinoma in 2017, treated successfully with surgical resection and subsequent monitoring. The relapse of disease occurred in January 2020. Despite maintaining a prolonged progression-free survival (PFS) with first-generation EGFR-TKI Afatinib, disease progression occurred in 2022 without detectable resistance mutations. Transition to second-generation TKI Furmonertinib resulted in poor control, with rapid progression including unusual bilateral breast metastases that exhibited inflammatory breast cancer-like peau d'orange changes. Standard chemotherapy achieved only short-term stability. Upon detecting a amplification mutation, treatment with Savolitinib was initiated. Remarkably, this led to significant clinical and radiographic improvement, notably resolving the peau d'orange appearance and reducing multiple lesions across the body.
This case underscores the importance of continuous genetic profiling and tailored treatment approaches in managing advanced lung adenocarcinoma, particularly when presenting with rare metastatic sites and complex genetic landscapes. The successful application of Savolitinib following the identification of a amplification mutation highlights its potential in overcoming resistance mechanisms in NSCLC, providing a significant therapeutic option for similarly challenging cases.
肺癌的远处转移主要发生在骨骼、肝脏、脑和肺，而乳腺是极其罕见的转移部位。关于肺癌发生乳腺转移的文献非常有限，乳腺转移瘤容易被误诊为原发性乳腺癌，在临床诊疗过程中需要仔细关注并加以鉴别。
该患者为63岁女性，2017年初被诊断为外显子21 L858R突变的左肺腺癌，经手术切除及后续监测成功治疗。2020年1月疾病复发。尽管使用第一代EGFR-TKI阿法替尼维持了较长时间的无进展生存期（PFS），但2022年疾病仍出现进展，且未检测到耐药突变。换用第二代TKI伏美替尼后病情控制不佳，出现快速进展，包括双侧乳腺出现不寻常转移，呈现出炎性乳腺癌样的橘皮样改变。标准化疗仅取得短期病情稳定。检测到 扩增突变后，开始使用赛沃替尼治疗。值得注意的是，这带来了显著的临床和影像学改善，特别是消除了橘皮样外观并减少了全身多处病灶。
该病例强调了在管理晚期肺腺癌时持续进行基因检测和采用个体化治疗方法的重要性，尤其是当出现罕见转移部位和复杂基因图谱时。在检测到 扩增突变后成功应用赛沃替尼突出了其在克服非小细胞肺癌耐药机制方面的潜力，为类似具有挑战性的病例提供了重要的治疗选择。
