奥希替尼治疗获得性表皮生长因子受体-酪氨酸激酶抑制剂耐药T790M突变肺腺癌晚期1例

Osimertinib in treatment of a T790M mutation advanced lung adenocarcinoma patient with acquired resistance to EGFR tyrosine kinase inhibitors

报告1例使用奥西替尼治疗表皮生长因子受体(epithelial growth factor receptor,EGFR)基因19外显子缺失突变耐药后T790M突变肺腺癌晚期患者。患者,女,72岁,无明显诱因出现左侧胸闷、气喘5 d于当地医院治疗,查胸部CT示双侧胸腔积液,右肺中叶占位,并纵隔淋巴结肿大。为求进一步治疗遂来郑州大学第一附属医院,入院完善相关检查,PET-CT示右肺中叶软组织肿块代谢较活跃,考虑肺癌,建议结合病理诊断;双侧锁骨上区、纵隔及右肺门多发淋巴结肿大,代谢活跃,考虑转移。不符合手术指征,未进行手术治疗,第1次CT引导下经皮肺穿刺活检确诊肺腺癌,基因检测示EGFR基因第19外显子缺失突变,于2017年11月29日开始服用吉非替尼,至2018年12月4日停止服用。期间复查CT发现右上肺结节较前增大,第2次CT引导下经皮肺穿刺活检结果示肺腺癌,基因检测示EGFR基因18外显子缺失突变,合并EGFR基因第20外显子T790M突变,于2018年12月4日开始服用奥希替尼至今,复查未见异常。

This article reports 1 case of advanced T790M lung adenocarcinoma treated with osimertinib after treatment of epithelial growth factor receptor(EGFR)gene 19 exon deletion mutation and drug resistance with osimertinib.The 72-years-old female presented left chest tightness and asthma for 5 d without obvious inducement and was treated at the local hospital.CT examination of the chest showed bilateral pleural effusion,mid-lobe occupation of the right lung,and mediastinal lymph node enlargement.In order to seek further treatment,she came to the First Affiliated Hospital of Zhengzhou University and was admitted to the hospital to complete relevant examinations.PET-CT showed that the metabolism of soft tissue mass in the middle of the right lung was relatively active.Bilateral supraclavicular area,mediastinum and right hilum multiple lymph node enlargement,metabolic activity,consider metastasis.The first CT-guided percutaneous lung biopsy confirmed lung adenocarcinoma,and the gene test showed that after EGFR gene exon 19 deletion mutation,the patient began to take gefitinib on November 29,2017 and stopped taking it on December 4,2018.The results of the second CT-guided percutaneous lung biopsy showed lung adenocarcinoma.The gene test showed EGFR gene 18 exon deletion mutation,and EGFR gene 20 exon T790M mutation.Osimertinib was taken since December 4,2018,and no abnormality was found.