Lai L, Meng W, Wei J, Zhang X, Tan Z, Lu Y, Hou E. Transformation of NSCLC to SCLC after 1st- and 3rd-generation
EGFR-TKI resistance and response to EP regimen and erlotinib: 2 CARE-compliant case reports.
Medicine (Baltimore) 2021;
100:e25046. [PMID:
33725888 PMCID:
PMC7969239 DOI:
10.1097/md.0000000000025046]
[Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE
Genotypic and histological evolution of non-small-cell lung cancer (NSCLC) into small-cell lung cancer (SCLC) has been described as a mechanism of acquired resistance to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) therapy. However, the number of clinical cases is rare.
PATIENT CONCERNS
Two lung adenocarcinoma patients with EGFR mutations who recurred after radical resection transformed into SCLC under treatment with the sequential first- and third-generation EGFR-TKIs.
DIAGNOSIS
The 2 cases were both confirmed as SCLC by pathological rebiopsy after EGFR-TKIs resistance.
INTERVENTIONS
Case 1 was treated with etoposide plus cisplatin (EP) regimen and erlotinib, while case 2 was treated with erlotinib and EP followed by oral etoposide.
OUTCOMES
Case 1 treated with EP only achieved 3-month progression-free survival (PFS), which is the first case that reported T790 M/C797S cis-mutation for osimertinib resistance before the SCLC transformation. However, case 2 treated with erlotinib and EP followed by oral etoposide, PFS lasted for 8 months.
LESSONS
The cases highlighted the importance of rebiopsy that identified pathologically SCLC transformation after EGFR-TKI resistance, and suggested the treatment of erlotinib plus EP followed by etoposide, which could provide a reference for such phenotype.
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