T790M mutation in stage IV EGFR-mutated NSCLC patient with acquired resistance reverted to original 19Del mutation after administration of a series of precision treatments: a case report.
T790M mutation in stage IV EGFR-mutated NSCLC patient with acquired resistance reverted to original 19Del mutation after administration of a series of precision treatments: a case report.
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获得性耐药IV期EGFR突变NSCLC患者T790M突变在一系列精准治疗后恢复为原始19Del突变：病例报告
DOI：
10.1093/pcmedi/pby013
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发表时间：
2018-12
影响因子：
5.3
通讯作者：
Zhu J
中科院分区：
文献类型：
--
作者：
Han J;Wang Y;Zhong L;Zhou H;Yu M;Li Y;Lu Y;Wang Y;Zhu J
摘要现有的研究尚未阐明第三代表皮生长因子受体（EGFR）酪氨酸激酶抑制剂（TKI）继发耐药的机制，也没有针对第三代EGFR-TKI耐药患者的标准治疗方法。该病例报告显示了一例男性患者的罕见突变模式，该患者病理诊断为携带EGFR外显子19缺失（19 Del）突变的非小细胞肺癌（NSCLC），在对第一代EGFR-TKI（吉非替尼）产生耐药性后获得了EGFR-T790 M突变。在患者对第三代TKI（奥希替尼）发生继发性耐药后，突变恢复为原始EGFR-19 Del突变。该患者最终在第二代TKI（阿法替尼）作为四线治疗后获得部分缓解（PR）。
Abstract Existing studies have yet to elucidate clearly the mechanisms of secondary resistance to third generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs), neither is there any established standard therapy for patients resistant to third generation EGFR-TKIs. This case report demonstrates a rare mutation pattern in a male patient with a pathologic diagnosis of non-small cell lung cancer (NSCLC) harboring an EGFR exon 19 deletion (19Del) mutation, who then acquired an EGFR-T790M mutation after developing resistance to the first generation EGFR-TKI (gefitinib). The mutation reverted to the original EGFR-19Del mutation after the patient developed secondary resistance against the third generation TKI (osimertinib). This patient eventually achieved partial response (PR) with second generation TKI (afatinib) as a fourth-line treatment.