贝伐珠单抗联合埃克替尼克服一例非小细胞肺癌患者奥希替尼耐药

doi:10.24920/003487

摘要/Abstract

摘要：

一名61岁的中国女性左肺上叶原发性肺癌患者,病理诊断为肺腺癌,伴有表皮生长因子受体（EGFR）19 del突变。给予埃克替尼治疗,病情在6个月后恶化。左肺下叶新发病变,CT引导穿刺活检确诊为肺内转移灶,ARMS-PCR检测发现EGFR T790M突变阳性。患者接受奥西替尼治疗2个月,缓解后病情再度进展。左肺下叶转移病灶再次进行活检,ARMS-PCR发现除EGFR 19 del突变外没有其它基因突变。再次应用埃克替尼治疗,但疾病进展迅速。加入贝伐珠单抗与埃克替尼联合治疗,2个周期后肺内病灶达到部分缓解。非小细胞肺癌患者奥希替尼治疗后维持EGFR敏感突变,而EGFR T790M突变转阴性为奥希替尼耐药的一种基因变化。此病例提示,第一代EGFR-TKIs与贝伐珠单抗联合治疗可能会克服其耐药性并延长患者生存期。

关键词: 表皮生长因子络氨酸酶抑制剂, 突变耐药, 非小细胞肺癌, 贝伐珠单抗

Abstract:

A 61-year-old Chinese woman was diagnosed as primary pulmonary adenocarcinoma of left superior lobe with epidermal growth factor receptor (EGFR) 19 del mutation positive. Treatment with icotinib was given, but her disease progressed after 6 months remission. CT-guide needle biopsy for the new lesion in inferior lobe of left lung demonstrated intrapulmonary metastasis, and EGFR gene panel by Amplification Refractory Mutation System Polymerase Chain Reaction (ARMS-PCR) confirmed EGFR T790M mutation. Treatment with osimertinib was initiated. After 2 months remission, the disease progressed. Re-biopsy was performed for the tumor in the inferior lobe of left lung, and ARMS-PCR demonstrated no other gene mutation except EGFR 19 del. Icotinib was re-challenged, but disease progressed continuously. Bevacizumab was added, and partial response was achieved after 2-cycle of combination therapy. The non-small cell lung cancer (NSCLC) in this case maintained EGFR activating mutation and lost EGFR T790M mutation was a genetic change after osimertinib treatment. This case suggests the re-challenge of the first-generation EGFR-TKIs combined with bevacizumab may overcome the tumor resistance and prolong survival of NSCLC patient.

Key words: Epidermal growth factor receptor-tyrosine kinase inhibitor, resistant mutation, non-small cell lung cancer, bevacizumab

Zhang Ling, Sun Lei, Mu Xiaoyan, Ji Youxin. Bevacizumab Combined with Icotinib Overcomes Osimertinib Resistance in a Patient of Non-Small Cell Lung Cancer[J].Chinese Medical Sciences Journal, 2019, 34(4): 292-296.

图/表 1

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