Genetic characterization drives personalized therapy for early-stage non-small-cell lung cancer (NSCLC) patients and survivors with metachronous second primary tumor (MST) A case report
Genetic characterization drives personalized therapy for early-stage non-small-cell lung cancer (NSCLC) patients and survivors with metachronous second primary tumor (MST) A case report
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遗传表征推动对早期非小细胞肺癌 (NSCLC) 患者和异时第二原发肿瘤 (MST) 幸存者的个性化治疗 病例报告
DOI：
10.1097/md.0000000000006221
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发表时间：
2017-03-01
期刊：
影响因子：
1.6
通讯作者：
Meng, Xue
中科院分区：
文献类型：
--
作者：
Ding, Xingchen;Wang, Linlin;Meng, Xue
理论基础：肺癌的发生发展是一个多基因参与的复杂过程。但分子基因检测通常只在晚期非鳞状非小细胞肺癌（NSCLC）中进行。酪氨酸激酶抑制剂（TKI）管理的价值是没有得到广泛认可的早期NSCLC.Patient Concerns：在这里，我们提出了一个男人的情况下，重度吸烟者最初提出IA期肺腺癌（LADC）。三年后肺叶切除术，他被诊断为晚期肺鳞状细胞癌（SCC），根据实验室，影像学和病理学检查。诊断该病例最初有一个早期LADC与L 858 R表皮生长因子受体（EGFR）突变。手术后3年发生了携带EGFR L 858 R/T790 M突变的晚期SCC。干预措施：我们采用了综合治疗，包括早期病变的手术切除和GP化疗和局部放疗作为一线治疗，沿着吉非替尼维持治疗晚期异时性第二原发肿瘤（MST）。结局：综合治疗，使我们的病人保持生存和无进展4.5 years.教训：该病例表明，在整个癌症进展过程中，应密切监测分子病理学的变化，以指导个性化治疗，改善预后。我们进一步审查了TKI对早期NSCLC和生存者中异时性第二原发性肿瘤（MST）的给药。
Rationale: The pathogenesis and progression of lung cancer is a complicated process in which many genes take part. But molecular gene testing is typically only performed in advanced-stage non-squamous non-small-cell lung cancer (NSCLC). The value of tyrosine kinase inhibitors (TKI) administration is not widely recognized with respect to early-stage NSCLC.Patient concerns: Here, we present a case of a man, heavy smoker who initially presented with stage IA lung adenocarcinoma (LADC). Three years after a lung lobectomy, he was diagnosed with advanced lung squamous cell carcinoma (SCC), according to laboratory, imaging, and pathological examinations.Diagnoses The case initially had an early-stage LADC with an L858R epidermal growth factor receptor (EGFR) mutation. A subsequent advanced SCC bearing EGFR L858R/T790M mutations occurred 3 years after surgery.Interventions: The comprehensive therapy we utilized, including surgical resection for the early-stage lesion and GP chemotherapy and local radiotherapy as the first line therapy along with gefitinib maintenance treatment for the advanced metachronous second primary tumors (MST).Outcomes: The synthetical therapy, have resulted in our patient with remaining alive and progression free for 4.5 years.Lessons: This case suggests that changes in molecular pathology should be monitored closely throughout cancer progression to guide personalized therapy and improve prognosis. We further review administration of TKI to early-stage NSCLC and to the metachronous second primary tumors (MST) in survivors.