文章摘要

EGFR突变晚期非小细胞肺癌患者1例

作者: 1陈 清, 1王 圣庄, 1鲍 洁兰, 1蔡 锦威, 1姜 玲, 1王 欣
1 柯城区人民医院血液肿瘤科,浙江 衢州 324000
通讯: 陈 清 Email: 894172552@qq.com
DOI: 10.3978/j.issn.2095-6959.2020.01.045

摘要

浙江省衢州市柯城区人民医院收治1例晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)。患者,女,65岁,无吸烟史,无肿瘤家族史。因“右下肺癌术后13年余,来院复查”入院。胸部增强CT示:两肺多发恶性肿瘤,左肺上叶最大层面约3.6 cm ×3.2 cm,右肺最大层面约5.9 cm ×3.5 cm,左侧第12肋膨胀性骨质破坏。头颅增强MRI示:双侧颞叶异常强化灶,大小约0.5 cm ×0.5 cm,考虑转移。左肺穿刺病理:(左)肺非小细胞癌,倾向腺癌。免疫组织化学:CK7(+),napsin-A(+),TTF-1(+),p40(−),p63(−),Ki-67(5%+)。基因检测:EGFR E19del突变。一线予“吉非替尼片(易瑞沙)”靶向治疗,治疗后肺部病灶明显缩小,颅内病灶消失。16个月左右后疾病进展,进展后血液EGFR T790M突变检测阳性,使用“甲磺酸奥西替尼片(泰瑞沙)”治疗,疾病持续缓解中。
关键词: 晚期非小细胞肺癌;表皮生长因子受体激酶抑制剂;EGFR突变;EGFR T790M突变

A case of advanced non-small cell lung cancer with EGFR mutation

Authors: 1CHEN Qing, 1WANG Shengzhuang, 1BAO Jielan, 1CAI Jinwei, 1JIANG Ling, 1WANG Xin
1 Department of Hematology and Oncology, Kecheng District People’s Hospital, Quzhou Zhejiang 324000, China

CorrespondingAuthor:CHEN Qing Email: 894172552@qq.com

Abstract

A 65-year-old female, never smoker, with advanced non-small cell lung cancer (NSCLC) was admitted to the Kecheng District People’s Hospital of Quzhou, Zhejiang Province. The patient denied a family history of cancer. Due to a 13-year surgery history of the right lower lung cancer, the patient wanted to conduct a review. Enhanced chest CT showed multiple malignant tumors in both lungs, the largest layer of the left upper lobe was about 3.6 cm ×3.2 cm, the largest part of the right lung was about 5.9 cm ×3.5 cm, and the left flank was expansive bone destruction. Enhanced cranial MRI showed abnormal enhancement of bilateral temporal lobe (about 0.5 cm ×0.5 cm), indicating metastasis. The pathology of left lung puncture was NSCLC and prone to adenocarcinoma. In the further immunohistochemistry study, the results demonstrated CK7 (+), napsin-A (+), TTF-1 (+), p40 (−), p63 (−), Ki-67 (5%+). The genetic testing of tissue identified a common EGFR mutation (E19del). Based on the above results, “gefitinib (Iressa)” was initiated as the first-line treatment. The lung lesions were significantly reduced and the intracranial lesions disappeared during gefitinib therapy. However, the disease progressed after 16 months and a novel EGFR mutation (T790M) was detected. Hence, the patient acquired another targeted therapy with “oxitinib mesylate (Terisha)”, and the disease continues to be relieved.
Keywords: advanced non-small cell lung cancer; EGFR kinase inhibitor; EGFR mutation; EGFR T790M mutation