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阿美替尼治疗 EGFR 突变型非小细胞肺癌相关急性呼吸窘迫综合征一例并文献复习

Successful rapid improvement of acute respiratory distress syndrome induced by EGFR-mutated non-small cell lung cancer with almonertinib: a case report.

机构信息

Department of Pulmonary and Critical Care Medicine, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, 510180, China.

Jinan University, Guangzhou, Guangdong, 510632, China.

出版信息

BMC Pulm Med. 2024 Sep 27;24(1):471. doi: 10.1186/s12890-024-03292-3.

Abstract

BACKGROUND

Acute respiratory distress syndrome (ARDS) is a life-threatening condition frequently encountered in critically ill patients, including those with advanced non-small cell lung cancer (NSCLC). Almonertinib, a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), has shown promise as a first-line treatment for NSCLC with classical EGFR mutations. However, its efficacy in NSCLC patients suffering from ARDS has not been well-documented.

CASE PRESENTATION

We report the case of a 63-year-old Chinese Han female with severe NSCLC complicated by ARDS. Upon hospital admission, the patient exhibited progressive dyspnea and required intubation to maintain oxygenation. Pathological analysis of bronchoalveolar lavage fluid sediment confirmed lung adenocarcinoma, and genetic testing of blood identified an EGFR E19 mutation. The patient was treated with almonertinib, resulting in significant clinical improvement and successful extubation after nine days. Radiographic imaging showed substantial reduction in pulmonary lesions, highlighting the efficacy of almonertinib.

CONCLUSION

This case represents the first documented successful treatment of ARDS induced by EGFR E19 mutated NSCLC using almonertinib. The favorable clinical response observed in this critically ill patient suggests that almonertinib may be a viable therapeutic option for managing severe complications in NSCLC. Further research is necessary to corroborate these findings and optimize dosage and toxicity management strategies for broader clinical application.

摘要

背景

急性呼吸窘迫综合征(ARDS)是一种危及生命的疾病,常发生在重症患者中,包括晚期非小细胞肺癌(NSCLC)患者。阿美替尼是一种第三代表皮生长因子受体(EGFR)酪氨酸激酶抑制剂(TKI),已被证明是治疗具有经典 EGFR 突变的 NSCLC 的一线药物。然而,其在合并 ARDS 的 NSCLC 患者中的疗效尚未得到充分证实。

病例介绍

我们报告了一例 63 岁的中国汉族女性,患有严重的 NSCLC 合并 ARDS。入院时,患者出现进行性呼吸困难,需要插管以维持氧合。支气管肺泡灌洗液沉淀物的病理分析证实为肺腺癌,血液基因检测发现 EGFR E19 突变。患者接受阿美替尼治疗,九天后临床症状显著改善并成功拔管。影像学检查显示肺部病变明显缩小,突出了阿美替尼的疗效。

结论

本病例代表了首例使用阿美替尼成功治疗 EGFR E19 突变 NSCLC 合并 ARDS 的病例。在这名重症患者中观察到的良好临床反应表明,阿美替尼可能是治疗 NSCLC 严重并发症的一种可行的治疗选择。需要进一步研究来证实这些发现,并优化剂量和毒性管理策略,以实现更广泛的临床应用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1344/11437641/e6208c716116/12890_2024_3292_Fig1_HTML.jpg

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