Hong E, Chen XE, Mao J, Zhou JJ, Chen L, Xu JY, Tao W. Sequential occurrence of T790M mutation and small cell lung cancer transformation in EGFR-positive lung adenocarcinoma: A case report. World J Clin Cases 2022; 10(9): 2836-2843 [PMID: 35434119 DOI: 10.12998/wjcc.v10.i9.2836]
Corresponding Author of This Article
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
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
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.
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.
