Tuberc Respir Dis.  2013 Mar;74(3):129-133.

Repeated Favorable Responses to Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors in a Case of Advanced Lung Adenocarcinoma

• Kim EY
• Kim YH
• Ban HJ
• Oh IJ
• Kwon YS
• Kim KS
• Kim YI
• Lim SC
• Kim YC

Abstract

The presence of epidermal growth factor receptor (EGFR) mutation is a prognostic and predictive marker for EGFR-tyrosine kinase inhibitor (TKI) therapy. However, inevitably, relapse occurs due to the development of acquired resistance, such as T790M mutation. We report a case of repeated responses to EGFR-TKIs in a never-smoked woman with adenocarcinoma. After six cycles of gemcitabine and cisplatin, the patient was treated by gefitinib for 4 months until progression. Following the six cycles of third-line pemetrexed, gefitinib retreatment was initiated and continued with a partial response for 6 months. After progression, she was recruited for an irreversible EGFR inhibitor trial, and the time to progression was 11 months. Although EGFR direct sequencing on the initial diagnostic specimen revealed a wild-type, we performed a rebiopsy from the progressed subcarinal node at the end of the trial. The result of peptide nucleic acid clamping showed L858R/L861Q.

Keyword

Adenocarcinoma; Receptor, Epidermal Growth Factor; Gefitinib

MeSH Terms

Adenocarcinoma
Cisplatin
Constriction
Deoxycytidine
Epidermal Growth Factor
Female
Glutamates
Guanine
Humans
Lung
Lung Neoplasms
Phosphotransferases
Quinazolines
Receptor, Epidermal Growth Factor
Recurrence
Retreatment
Pemetrexed
Adenocarcinoma
Cisplatin
Deoxycytidine
Epidermal Growth Factor
Glutamates
Guanine
Lung Neoplasms
Phosphotransferases
Quinazolines
Receptor, Epidermal Growth Factor

Figure

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  Figure 1 Initial chest radiography shows diffuse patchy consolidations with geographic ground glass opacities in the left upper and lower lung fields.

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  Figure 2 Computed tomography scans are displayed as the timings of (A, D, G) baseline before treatments, (B, E, H) 1-month follow-up after treatments, and (C, F, I) end of treatments. After sixth cycle of gemcitabine and cisplatin, (A) multiple consolidations were developed in left upper lobe and (B) were improved by initial gefitinib treatment. (C) Newly appeared metastatic nodules were shown in left lower lobe after 4 months. Followed by sixth cycle of pemetrexed, (D) multiple metastatic nodules were prominent in both lungs. (E) These lesions were improved by gefitinib retreatment, but (F) residual left upper lobar nodule and tiny metastases were progressed 6 months later. (G) Both lung nodules were markedly aggravated 1 month after gefitinib retreatment. (H) Dramatic response was shown after PF-00299804 trial, but metastatic subcarinal lymphadenopathy was noted in 11-month follow-up scan.

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  Figure 3 The epidermal growth factor receptor (EGFR) status detected by peptide nucleic acid (PNA) clamping after treatment with EGFR-tyrosine kinase inhibitor indicate two mutations in exon 21 (L858R/L861Q) and exon 20 (T790M). ΔCt: standard Ct - sample Ct; ΔCt-1: sample Ct - (non-PNA Ct).

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