1例肺腺癌合并深静脉血栓及EGFR19del/T790M/cis-C797S突变的治疗分析

A Case Analysis of Lung Adenocarcinoma with Deep Venous Thrombosis and EGFR 19del/T790M/cis-C797S Mutation

1例56岁女性患者,诊断肺腺癌Ⅳ期合并表皮生长因子(EGFR)(+),靶向治疗2年余。因脑转移伴颅内水肿入院,给予地塞米松联合贝伐珠单抗治疗5 d后,静脉彩超提示右下肢静脉多发血栓,先后给予华法林3 mg·d^-1、4.5 mg·d^-1治疗,10 d后患者右下肢水肿减轻。血浆基因检测示:EGFR19del/T790M/cis-C797S三重突变,给予布格替尼(90 mg,po,qd)和西妥昔单抗(600 mg,iv,每月1次)治疗,1个月后患者胸部彩超提示大量胸水,胸部CT提示疾病进展。因拒绝抗肿瘤治疗,给予胸腔积液穿刺置管引流对症处理。

A 56-year-old female patient diagnosed as stage Ⅳ lung adenocarcinoma and genetic test tips EGFR( +) received targeted therapy for more than 2 years. Dexamethasone and bevacizumab were applied to reduce the intracranial edema by brain metastasis.After 5 days,the vein color ultrasound suggested multiple thrombosis in the right lower limb. Warfarin was applied at the dose of 3 mg· d^-1 and 4.5 mg·d^-1 successively. After 10 days,the edema of right lower limb was reduced. Genetic testing of ct DNA from plasma revealed a newly acquired C797 S mutation in cis with T790 M. A combination of brigatinib( 90 mg,daily,po) and cetuximab( 600 mg,monthly,iv) was administered. After one month,chest color ultrasound indicated a large amount of pleural effusion,and chest CT indicated progressive disease. The pleural effusion was treated by puncture and drainage because of the patient’s refusal of antitumor treatment.