纳武利尤单抗单药后线治疗晚期EGFR合并TP53、RB1共突变肺腺癌1例

Treatment of a patient with lung adenocarcinoma harboring co-mutations of EGFR,TP53 and RB1 with Nivolumab as the posterior line treatment:a case report

报道1例EGFR合并TP53、RB1共突变62岁晚期肺腺癌患者的诊治过程。本例患者一线阿法替尼靶向治疗无进展生存仅4个月,二线尝试奥希替尼无效,三线培美曲塞联合卡铂化疗病情持续进展并出现巨大腹腔转移灶及腹腔感染,四线免疫治疗获得部分缓解并持续至随访期结束。本例患者的诊治经验提示驱动基因敏感突变合并共突变的患者单纯靶向治疗效果欠佳,但后线可能会从免疫治疗中获益,短期内使用广谱抗生素不是延后免疫治疗的指征,免疫治疗的疗效预测体系有待进一步完善。

To report the diagnosis and treatment process for a 62-year-old patient with lung adenocarcinoma harboring mutations of EGFR,TP53 and RB1.The progress-free survival lasted only 4 months after first-line Afatinib-targeted therapy,second-line trial Osetinib was ineffective,the disease continued to progress with huge abdominal metastasis and abdominal infection after third-line Pemetrexed combined with Carboplatin chemotherapy.Fourth-line immunotherapy achieved partial remission that persisted to the end of the follow-up period.The diagnosis and treatment experience of this patient suggested that the patients with driver gene sensitive mutations combined with comutations have poor results on targeted therapy alone.However,the posterior line may be benefit from immunotherapy.The use of broad-spectrum antibiotics is not an indication for delayed immunotherapy,and the efficacy prediction system of immunotherapy needs to be further improved.