Sequential occurrence of T790M mutation and small cell lung cancer transformation in EGFR-positive lung adenocarcinoma: A case report

doi:10.12998/wjcc.v10.i9.2836

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 10, Issue 9

This Article

Peer-Review Report of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (5568)

All Articles published online

The chart showing PDF series, WORD series, HTML series, Figures (1-4) series.

Item

Count

PDF

297

WORD

HTML

2427

Figures (1-4)

597

Sum=3374

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

649

Download

1547

Sum=2196

Mar 26, 2022 (publication date) through Mar 2, 2026

Times Cited of This Article

Times Cited (3)

Journal Information of This Article

Publication Name

World Journal of Clinical Cases

ISSN

2307-8960

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

- Full Article with Cover (PDF)
- Full Article (XML)

Case Report

World J Clin Cases. Mar 26, 2022; 10(9): 2836-2843
Published online Mar 26, 2022. doi: 10.12998/wjcc.v10.i9.2836

Sequential occurrence of T790M mutation and small cell lung cancer transformation in EGFR-positive lung adenocarcinoma: A case report

Er Hong, Xi-Er Chen, Jia Mao, Jing-Jing Zhou, Ling Chen, Jia-Yi Xu, Wei Tao

Er Hong, Xi-Er Chen, Jia Mao, Jing-Jing Zhou, Ling Chen, Jia-Yi Xu, Department of Respiratory, Ningbo Municipal Hospital of Traditional Chinese Medicine, Affiliated to Zhejiang Chinese Medical University, Ningbo 315000, Zhejiang Province, China

Wei Tao, Department of Radiology, Ningbo Municipal Hospital of Traditional Chinese Medicine, Affiliated to Zhejiang Chinese Medical University, Ningbo 315000, Zhejiang Province, China

Author contributions: Hong E, Chen XE and Tao W collaborated in data collection, literature review and writing the manuscript; Mao J, Zhou JJ analyzed the data from the patient; Chen L and Xu JY were responsible for the treatment and management of the patient; All authors read and approved the final manuscript.

Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.

Conflict-of-interest statement: The authors declare that they have no conflicts of interest.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Wei Tao, MD, Chief Doctor, Department of Radiology, Ningbo Municipal Hospital of Traditional Chinese Medicine, Affiliated to Zhejiang Chinese Medical University, No. 819 Liyuan North Road, Haishu District, Ningbo 315000, Zhejiang Province, China. 70225027@qq.com

Received: August 16, 2021
Peer-review started: August 16, 2021
First decision: November 6, 2021
Revised: November 17, 2021
Accepted: February 16, 2022
Article in press: February 16, 2022
Published online: March 26, 2022
Processing time: 218 Days and 1.5 Hours

Abstract

BACKGROUND

The emergence of secondary drug resistance when treating epidermal growth factor receptor (EGFR) mutated non-small cell lung cancer (NSCLC) using EGFR-tyrosine kinase inhibitors (EGFR-TKIs), seriously affects the therapeutic efficacy and survival of patients. Here, we report a case of advanced NSCLC focusing on the application of multiple biopsy modalities to reveal the development of multiple resistance mechanisms during targeted therapies.

CASE SUMMARY

A 54-year-old male patient presented with EGFR 19Del-mutated advanced lung adenocarcinoma, and exhibited the development of a T790M mutation during initial TKI treatment. Following 3 mo of Osimertinib treatment, a mixed response was observed. Tissue biopsy of the progressive lesion showed transformation to small cell lung cancer (SCLC) harboring RB1 and TP53 mutations, with loss of the original T790M mutation. A standard chemotherapy regimen with Anlotinib for SCLC was administered. Repeat biopsy revealed adenocarcinoma combined with SCLC after tumor progression. The patient’s overall survival was 24 mo.

CONCLUSION

Multiple biopsy modalities can reveal the development of multiple resistance mechanisms which help with treatment decision-making. Comprehensive treatment regimens according to the drug resistance mechanism significantly improved the prognosis of such patients.

Keywords: Adenocarcinoma; Epidermal growth factor receptor-tyrosine kinase inhibitor; Epidermal growth factor receptor-T790M mutation; Small cell lung cancer transformation; Chemotherapy; Case report

Core Tip: The emergence of secondary drug resistance seriously affects the efficacy of tyrosine kinase inhibitor (TKI) treatment and prognosis of patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer. EGFR-T790M mutation and tumor phenotype transformation are common drug resistance mechanisms in the first-generation TKI treatment process. Thus, it is necessary to determine the potential mechanisms using multiple biopsy methods with the aim of selecting appropriate and effective therapeutic drugs and extending the survival of patients with lung cancer.