奥西替尼治疗T790M突变晚期肺腺癌1例
| 作者: |
1杨晓梅,
1侯永超,
1殷星,
1王梅云
1 邯郸市第一医院肿瘤放疗科，河北 邯郸 056000 |
| 通讯: |
王梅云
Email: 2953296976@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2019.11.042 |
摘要
患者，男，68岁，2017年2月患者以无明显诱因出现乏力6个月为首发症状，肺CT示右肺下叶占位。于2017年2月24日行右肺下叶切除术+纵膈淋巴结清扫术，术后病理示低分化腺癌。术后基因检测示EGFR 19-del突变(组织)。术后行4周期化学药物治疗(以下简称为化疗)(培美曲赛0.8 g d1+顺铂60 mg/d1~2，21 d为1个周期)，末次化疗时间为2017年6月6日。于2017年6月29日行术后辅助放疗：右肺癌原瘤床区外放0.8 cm设为计划肿瘤体积(planning gross tumor volume，PGTV)，总剂量63 Gy/30 F/6周，2.1 Gy/F；纵隔淋巴结引流区设为临床靶区(clinical target volume，CTV)，CTV+0.5 cm设为计划靶区(planning target volume，PTV)，总剂量54 Gy/30 F/6周，1.8 Gy/F。疗效评估：完全缓解(complete response，CR)。无病生存期(disease-free survival，DFS)为13个月。2018年4月出现脑转移，于2018年4月11日行吉非替尼靶向治疗(250 mg，1次/d)，无进展生存期(progression-free survival，PFS)为11个月，脑转移灶完全消失，疗效评估：部分缓解(partial response，PR)。2019年1月再次发现脑转移，2019年3月再次行基因检测(血液)，结果示Exon 20 T790M突变阳性。2019年3月5日至今行奥希替尼靶向(80 mg，1次/d)治疗中，疗效评估：PR。
关键词：
肺腺癌；奥西替尼；T790M突变；靶向治疗；脑转移
Treatment of advanced lung adenocarcinoma with T790M mutation with Osimertinib: A case report
CorrespondingAuthor: WANG Meiyun Email: 2953296976@qq.com
DOI: 10.3978/j.issn.2095-6959.2019.11.042
Abstract
The first symptom of a 68-year-old man was lacking of strength for 6 months (February 2017). CT showed an occupying lesion in the right middle lung. Resection of the right inferior lobe of lung combined with mediastinal lymph node dissection were performed in February 24, 2017. Postoperative pathology showed poorly differentiated adenocarcinoma. Postoperative gene detection showed EGFR 19-del mutation (the test specimen is a tissue). Four cycles of chemotherapy were performed after operation (Pemetrexed disodium 0.8 g d1 + Cisplatin 60 mg/d1~2, 21 d/cycle). The last chemotherapy time was June 6, 2017. Postoperative auxiliary radiotherapy was performed in June 29, 2017. The specific content was: planning gross tumor volume (PGTV) was set as 0.8 cm outside the primary tumor bed of the right lung cancer. The total dose was 63 Gy/30 F/6 weeks, 2.1Gy/; clinical target volume (CTV) was set as mediastinal lymph node drainage area. Planning target volume (PTV) was set as 0.5 cm outside CTV. The total dose was 54 Gy/30 F/6 weeks, 1.8 Gy/F. The valuation of curative effect was CR. DFS: 13 months. MRI showed multiple brain metastases in April, 2018. Targeted therapy with Gefitinib was performed in April 11, 2018 (250 mg, 1 time/d). Progression-free survival (PFS) was 11 months. Brain metastases disappeared completely. The valuation of curative effect was PR. MRI showed multiple brain metastases in Jan 2019. The second gene detection was performed in March, 2019, which showed Exon 20 T790M mutation. Targeted therapy with Osimertinib was performed in March 5, 2019 (80 mg, 1 time/d). The valuation of curative effect was PR.
Keywords：
lung adenocarcinoma; osimertinib; T790M mutation; targeted therapy; brain metastases