Triple administration of osimertinib followed by chemotherapy for advanced lung adenocarcinoma: A case report

BACKGROUND 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.CASE SUMMARY 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 rechallenge 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.CONCLUSION This case may provide some selective therapeutic options for NSCLC patients with acquired drug-resistance who were previously controlled on osimertinib treatment.

Traditional Chinese medicinal herbs combined with epidermal growth factor receptor tyrosine kinase inhibitor for advanced non-small cell lung cancer: a systematic review and meta-analysis

BACKGROUND： Epidermal growth factor receptor tyrosine kinase inhibitor （EGFR-TKI） targeted treatment has been a standard therapy for advanced non-small cell lung cancer （NSCLC）, but it is not tolerated well by all patients. In China, some studies have reported that traditional Chinese medicinal herbs （TCMHs） may increase efficacy and reduce toxicity when combined with EGFR-TKI, but outside of China few studies of this kind have been attempted. OBJECTIVE： This study is intended to systematically review the existing clinical evidence on TCMHs combined with EGFR-TKI for treatment of advanced NSCLC. SEARCH STRATEGY： PubMed, the Cochrane Library, the Excerpta Medica Database （EMBASE）, the China BioMedical Literature （CBM）, and the China National Knowledge Infrastructure （CNKI） and web site of the American Society of Clinical Oncology （ASCO）, the European Society for Medical Oncology （ESMO）, the World Conference of Lung Cancer （WCLC） were searched; the search included all documents published in English or Chinese before October 2013. INCLUSION CRITERIA： We selected randomized controlled trials based on specific criteria, the most important of which was that a TCMH plus EGFR-TKI treatment group was compared with an EGFR-TKI control group in patients with advanced NSCLC. DATA EXTRACTION AND ANALYSIS： The modified Jadad scale was used to assess the quality of studies. For each included study, patient characteristics, treatment details, therapeutic approach and clinical outcomes were collected on a standardized form. When disagreements on study inclusion or data extracted from a study emerged, the consensus of all coauthors provided the resolution. The clinical outcome metrics consisted of objective response rate （ORR; complete response ＋ partial response divided by the total number of patients）, disease control rate （DCR; complete response ＋ partial response ＋ no change divided by the total number of patients）, survival rate, improved or stabilized Karnofsky performance status （KPS）, and severe toxicity. RevMan 5.0 software was used for data syntheses and analyses. Risk ratio （RR） and 95% confidence interval （CI） were calculated; if the hypothesis of homogeneity was not rejected （P〉0.1, I2〈50%）, the fixed-effect model was used to calculate the summary RR and the 95% CI. Otherwise, a random-effect model was used.