1例晚期EGFR阳性非小细胞肺癌的联合治疗

Combination therapy in the treatment of advanced EGFR-mutated non-small cell lung cancer: A case report

上海市胸科医院(上海交通大学附属胸科医院)收治了1例EGFR阳性非小细胞肺癌(non-small cell lung cancer,NSCLC)患者,男,48岁,因“胸闷、胸痛、气促2周”于2015年6月16日入院。胸部CT见右侧胸膜多发结节影、右下叶阴影、右侧胸腔积液。右侧胸腔闭式引流包埋病理提示腺癌。胸水基因检测结果示:EGFR19外显子缺失突变(19del)。一线治疗采用标准含铂双药化疗联合EGFR-TKI靶向治疗,后以单药培美曲赛联合靶向维持,疗效达部分缓解(partial regression,PR),无进展生存(progression-free survival,PFS)达15个月,二线治疗加用贝伐珠单抗后疾病稳定(stable disease,SD),PFS达18个月,三线治疗采用三代EGFR-TKIs联合贝伐珠单抗,最佳疗效完全缓解(complete regression,CR),患者目前仍在随访中,总生存期(overall survival,OS)已超50个月。联合治疗可显著延长晚期NSCLC患者的生存。

A 48-year-old male with EGFR-positive non-small cell lung cancer(NSCLC),presented with chest tightness,chest pain,and shortness of breath for the past two weeks was admitted into the Shanghai Chest Hospital on June 16,2015.Chest CT showed multiple nodules on the right pleura,shadow in the right lower lobe,and right-sided pleural effusion.Pathological and histochemical analysis of pleural effusion suggested lung adenocarcinoma.The genetic test showed EGFR 19 exon deletion mutation(19del).The patient was diagnosed with advanced EGFRmutated lung adenocarcinoma and treated with standard platinum-based chemotherapy combined with EGFRTKIs as the first-line regimen followed by pemetrexed and gefitinib as a maintenance therapy.Partial regression(PR)was observed and progression-free survival(PFS)achieved 15 months for the first-line.Bevacizumab was additionally administered in the second-line and stable disease(SD)with a PFS of 18 months were observed.EGFR 790 mutation was displayed after disease progression.The third-line treatment was composed of thirdgeneration EGFR-TKIs and bevacizumab.Chest CT showed a complete regression(CR)and the patient is still under follow-up.The overall survival(OS)has exceeded 50 months.Combination therapy provides survival benefit in the treatment of advanced EGFR-mutated NSCLC.