Published online Apr 16, 2021. doi: 10.12998/wjcc.v9.i11.2627
Peer-review started: December 7, 2020
First decision: December 30, 2020
Revised: January 11, 2021
Accepted: January 27, 2021
Article in press: January 27, 2021
Published online: April 16, 2021
Processing time: 116 Days and 10.7 Hours
Osimertinib is the recommended first-line treatment for adult patients with epidermal growth factor receptor (EGFR) mutation positive advanced or metastatic non-small cell lung cancer (NSCLC). However, primary or acquired resistance to EGFR-tyrosine kinase inhibitors (EGFR-TKIs) seems inevitable, and when drug-resistance occurs during treatment with osimertinib, the standard of care is to discontinue the TKI.
A 57-year-old female patient with lung adenocarcinoma presented with an irritating cough accompanied by chest distress of one month duration. An enhanced head magnetic resonance imaging scan showed brain metastases. An EGFR mutation (exon 21 L858R) was detected in pleural fluid. The patient was treated with oral osimertinib (80 mg once daily) from January 2018 but developed progressive disease on December 2018. She was then successfully treated with re-challenge and tri-challenge with osimertinib (80 mg once daily) by resensitization chemotherapy twice after the occurrence of drug-resistance to osimertinib, and to date has survived for 31 mo.
This case may provide some selective therapeutic options for NSCLC patients with acquired drug-resistance who were previously controlled on osimertinib treatment.
Core Tip: Osimertinib is the first-line recommended treatment for adult patients with epidermal growth factor receptor mutation positive advanced or metastatic non-small cell lung cancer. Once drug-resistance occurs in osimertinib, the standard of care is to discontinue the tyrosine kinase inhibitor. To the best of our knowledge, this is the first report of successful re-challenge and tri-challenge with osimertinib administered via multiple re-sensitization chemotherapy protocols. This case provides a useful reference for prolonging the efficacy of osimertinib.