文章摘要

IV期EGFR阳性肺腺癌综合治疗1例并文献复习

作者: 1李 亚丹, 1王 猛, 1周 志刚, 1杜 可朴, 1李 帅, 1高 飞, 1王 阳阳, 1高 梦宇
1 郑州大学第一附属医院放射科,郑州 450052
通讯: 周 志刚 Email: wintersweetpeak@163.com
DOI: 10.3978/j.issn.2095-6959.2020.02.041

摘要

报告1例IV期表皮生长因子受体(epidermal growth factor receptor,EGFR)阳性肺腺癌患者,在治疗过程中局部治疗及多次活体组织检查(以下简称活检)在综合治疗中起重要作用。患者,女,76岁,2017年2月以“持续背部疼痛1个月余,发现左肺占位1周”为主诉来郑州大学第一附属医院就诊。外院PET-CT检查示左肺上叶占位代谢活跃,考虑肺癌,胸11椎体、胸12椎体及腰2椎体代谢活跃,考虑转移。行肺占位穿刺活检,穿刺病理示:肺腺癌,EGFR第19外显子缺失突变。诊断为“左肺腺癌cT2aN0M1c IVB期”。一线治疗方案:“靶向治疗+局部治疗”(吉非替尼+椎体转移癌微波消融并椎体成形术+唑来膦酸),无进展生存(progression-free survival,PFS)8个月。2017年10月疾病出现局部进展,再次行穿刺活检,病理示:肺腺癌,EGFR第19外显子缺失突变。治疗方案:“靶向治疗+局部治疗”(吉非替尼+左肺癌射频消融术),PFS为4个月。2018年2月疾病出现快速进展,第3次穿刺活检肺新发转移结节,病理示:肺腺癌,EGFR第19外显子缺失突变。EGFR第20外显子T790M错义突变。二线治疗方案:靶向药物(甲磺酸奥希替尼),PFS为18个月。2019年8月疾病出现快速进展,肺多发结节,脑多发结节。第4次穿刺活检病理示:EGFR 第19外显子缺失突变。EGFR 第20外显子T790M 错义突变。三线治疗方案:化学药物治疗(培美曲塞二钠+洛铂+重组人血管内皮抑制素)2个周期。患者目前仍在随访中。
关键词: 非小细胞肺癌;IV期;活体组织检查;局部治疗

Comprehensive treatment of stage IV EGFR positive lung adenocarcinoma: A case report and literature review

Authors: 1LI Yadan, 1WANG Meng, 1ZHOU Zhigang, 1DU Kepu, 1LI Shuai, 1GAO Fei, 1WANG Yangyang, 1GAO Mengyu
1 Department of Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

CorrespondingAuthor:ZHOU Zhigang Email: wintersweetpeak@163.com

Abstract

A patient with stage IV epidermal growth factor receptor (EGFR)-positive lung adenocarcinoma admitted to the First Affiliated Hospital of Zhengzhou University demonstrated that multiple biopsy and local treatment played an important role in the treatment. The patient, female, 76 years old, came to our hospital for complaints in February 2017 because of “continuous back pain for more than 1 month and found left lung mass for 1 week”. PET-CT examination in the external hospital suggested that the left upper lobe occupied the metabolism of the upper lobe. Considering lung cancer, the T11, T12 and L2 vertebral bodies were active and metastatic. Lung biopsy, puncture pathology showed: lung adenocarcinoma, EGFR 19 exon deletion mutation. The diagnosis was “left lung adenocarcinoma cT2aN0M1c IVB phase”. First-line treatment: “targeted therapy + topical treatment” (gefitinib + vertebral metastases microwave ablation and vertebroplasty + zoledronic acid), Progression-free survival (PFS) for 8 months. In October 2017, local disease progressed, and a biopsy was performed again. The pathology showed: lung adenocarcinoma, EGFR exon 19 deletion mutation. Treatment plan: “targeted therapy + topical treatment” (gefitinib + left lung cancer radiofrequency ablation), PFS for 4 months. In February 2018, the disease progressed rapidly, and the third puncture biopsy targeted new metastasis of the lung. The pathology showed: lung adenocarcinoma, EGFR exon 19 deletion mutation. EGFR 20exon T790M missense mutation. Second-line treatment: targeted drug (oheptinib mesylate), PFS for 18 months. In August 2019, the disease progressed rapidly, with multiple nodules in the lungs and multiple nodules in the brain. The fourth biopsy path showed: EGFR exon 19 deletion mutation. EGFR exon 20 T790M missense mutation. Three-line treatment regimen: chemotherapy (pemetrexed + lobaplatin + recombinant human endostatin) 2 cycles. The patient is still in follow-up.
Keywords: non-small cell lung cancer; stage IV; biopsy; topical treatment