Niu Haiyu, Song Feixue, Zhou Xiaochun, Jin Qiaoying, Liu Yating, Luo Benxin, Wei Hanwen
Department of Oncology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, China.
Department of Nephrology, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou, China.
Front Oncol. 2025 Jul 3;15:1566768. doi: 10.3389/fonc.2025.1566768. eCollection 2025.
Lung adenocarcinoma is a common malignancy in clinical practice, but the coexistence of lung and gastric adenocarcinomas in a single patient is rare. This report presents the case of a 70-year-old male with a history of smoking for over 30 years, diagnosed with both lung adenocarcinoma and gastric adenocarcinoma through lung biopsy and gastroscopy. Following comprehensive evaluations and exclusion of treatment contraindications, the patient underwent a therapeutic regimen comprising Sintilimab combined with nab-paclitaxel and cisplatin. Genetic testing of the lung cancer tissue identified mutations in the epidermal growth factor receptor () gene, specifically p.L858R in exon 21 and p.T790M in exon 20. Consequently, the patient was prescribed Almonertinib at a dose of 110 mg/day to target these mutations. Approximately 72 h after initiating Almonertinib, the patient developed dizziness and nausea, accompanied by hypotension (blood pressure: 80/58 mmHg). Echocardiographic findings and NT-proBNP levels indicated no structural cardiac abnormalities or significant dysfunction. Almonertinib was discontinued, but subsequent attempts to reintroduce the drug consistently resulted in hypotension. After cardiology specialists evaluation, the hypotension was attributed to Almonertinib, prompting its permanent discontinuation. The treatment was adjusted to replace Almonertinib with Furmonertinib at a dose of 80 mg/day for lung adenocarcinoma, while maintaining the initial immunotherapy and chemotherapy regimen for gastric adenocarcinoma. Following these adjustments, the patient experienced no recurrence of hypotension. This case report reviews the literature to explore potential mechanisms of Almonertinib-induced hypotension and offers insights into the prevention, diagnosis, and management of similar adverse events in clinical practice.
肺腺癌是临床实践中常见的恶性肿瘤，但同一患者同时存在肺腺癌和胃腺癌的情况较为罕见。本报告介绍了一名70岁男性患者，有30多年吸烟史，通过肺活检和胃镜检查诊断为肺腺癌和胃腺癌。在进行全面评估并排除治疗禁忌证后，患者接受了包括信迪利单抗联合白蛋白结合型紫杉醇和顺铂的治疗方案。对肺癌组织进行基因检测，发现表皮生长因子受体（EGFR）基因存在突变，具体为外显子21的p.L858R和外显子20的p.T790M。因此，患者被给予阿美替尼，剂量为110毫克/天，以针对这些突变。在开始使用阿美替尼约72小时后，患者出现头晕、恶心，并伴有低血压（血压：80/58 mmHg）。超声心动图检查结果和NT-proBNP水平显示心脏结构无异常或明显功能障碍。停用阿美替尼，但随后再次尝试使用该药物均导致低血压。经心脏科专家评估，低血压归因于阿美替尼，促使其永久停用。治疗方案调整为将阿美替尼替换为伏美替尼，用于治疗肺腺癌，剂量为80毫克/天，同时维持针对胃腺癌的初始免疫治疗和化疗方案。经过这些调整后，患者未再出现低血压复发。本病例报告回顾了文献，探讨阿美替尼引起低血压的潜在机制，并为临床实践中类似不良事件的预防、诊断和管理提供见解。
