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表皮生长因子受体(EGFR)突变型肺腺癌转化为小细胞肺癌:一例报告及文献综述

EGFR-mutant lung adenocarcinoma transformed into small cell Lung cancer: A case report and literatures review.

作者信息

Chen Jinhong, Huang Hongxiang, Zhong Peiyuan, Peng Sujuan, Zhu Xie, Ding Xinjing, Wang Fen, Kong Ping, Song Tiantian, Lu Zhihui, Chen Li

机构信息

Department of Oncology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.

Department of Oncology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, China.

出版信息

Respir Med Case Rep. 2025 Apr 18;55:102219. doi: 10.1016/j.rmcr.2025.102219. eCollection 2025.

Abstract

Advances in molecular biology have positioned epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) as highly effective therapies for patients with EGFR-mutant carcinomas. However, the inevitable emergence of acquired resistance significantly limits their long-term efficacy. Among resistance mechanisms, the transformation of lung adenocarcinoma to small cell lung cancer (SCLC) following EGFR-TKIs therapy is an uncommon but clinically important phenomenon contributing to treatment failure. We present a case of SCLC transformation in a patient with EGFR-mutant lung adenocarcinoma after 8 months of first-line osimertinib therapy. Following 4 cycles of etoposide combined with lobaplatin chemotherapy, adenocarcinoma cells regained predominance, illustrating a dynamic histological shift between adenocarcinoma and SCLC phenotypes. Subsequent treatment with 2 cycles of chemotherapy plus osimertinib resulted in disease stabilization. However, multiple brain metastases were identified 3 months after completing 6 cycles of chemotherapy. This case underscores the bidirectional histological plasticity between lung adenocarcinoma and SCLC during treatment and highlights the critical importance of repeated biopsies for guiding management strategies in the context of resistance. We also provide a comprehensive review of the clinical manifestations, underlying mechanisms, predictive biomarkers, and therapeutic approaches for SCLC transformation.

摘要

分子生物学的进展已将表皮生长因子受体酪氨酸激酶抑制剂(EGFR-TKIs)定位为EGFR突变型癌症患者的高效治疗方法。然而,获得性耐药的不可避免出现显著限制了它们的长期疗效。在耐药机制中,EGFR-TKIs治疗后肺腺癌向小细胞肺癌(SCLC)的转变是一种不常见但在临床上很重要的导致治疗失败的现象。我们报告一例在一线使用奥希替尼治疗8个月后,EGFR突变型肺腺癌患者发生SCLC转化的病例。在接受4个周期的依托泊苷联合洛铂化疗后,腺癌细胞重新占主导地位,这表明腺癌和SCLC表型之间存在动态的组织学转变。随后进行2个周期的化疗加奥希替尼治疗使疾病稳定。然而,在完成6个周期化疗3个月后发现了多发脑转移。该病例强调了治疗期间肺腺癌和SCLC之间双向的组织学可塑性,并突出了重复活检对于指导耐药情况下管理策略的至关重要性。我们还对SCLC转化的临床表现、潜在机制、预测生物标志物和治疗方法进行了全面综述。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/856d/12076789/a35685cb9db2/gr1.jpg

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