奥希替尼联合赛沃替尼靶向治疗EGFR-TKI耐药伴发MET扩增的NSCLC 1例报告及文献复习

doi:10.13481/j.1671-587X.20230330

摘要/Abstract

摘要：

目的探讨奥希替尼联合赛沃替尼靶向治疗表皮生长因子受体（EGFR）-酪氨酸激酶抑制剂（TKI）获得性耐药的非小细胞性肺癌（NSCLC）并发中枢神经系统（CNS）转移患者的疗效，为该病靶向治疗提供依据。方法收集1例EGFR基因第19外显子非移码缺失突变伴发间质表皮转化因子（MET）扩增的NSCLC并发CNS转移患者的临床资料，并结合文献复习，分析其临床特征、治疗方法、靶向治疗的耐药机制及耐药后治疗方案。结果患者，女性，47岁，3年前于本院明确诊断为肺腺癌，基因检测结果提示存在EGFR基因第19外显子非移码缺失突变，给予埃克替尼靶向治疗。治疗18个月后基因检测，存在Exon20-T790M突变，改用口服奥希替尼靶向治疗。12个月后复查，疾病进展并发CNS转移，基因检测提示存在MET扩增，改为口服奥希替尼联合安罗替尼治疗。2个多月后复查发现疾病进一步进展，调整治疗方案为奥希替尼联合赛沃替尼靶向治疗。1和4个月后复查胸部CT及头颅MRI，肺部病变和脑部病变较之前明显缩小。结论对于长期靶向治疗后出现EGFR-TKI耐药伴发MET扩增的NSCLC并发CNS转移的患者，采用奥希替尼联合赛沃替尼靶向治疗短期内可明显控制患者肺部及中枢神经系统的疾病进展。

关键词: 癌，非小细胞性肺, 脑转移, 靶向治疗, 奥希替尼, 赛沃替尼

Abstract:

Objective To investigate the curative effect of osimertinib combined with savolitinib targeted therapy in the patients with non-small cell lung cancer（NSCLC） and central nervous system（CNS） metastasis with acquired resistance to epidermal growth factor receptor（EGFR）-tyrosine kinase inhibitor（TKI）， and to provide the reference for the targeted therapy for the disease. Methods The clinical data of one NSCLC complicated with CNS metastasis patient with non-frameshift deletion mutation in exon 19 of the EGFR gene complicated with MET amplification were collected， and the clinical characteristics， treatment methods， drug resistance mechanisms of targeted therapy， and treatment methods after drug resistance were analyzed combined with the literature review. Results The patient， female，47 years old， was diagnosed as lung adenocarcinoma in our hospital 3 years ago. The genetic test results showed that there was a non-frameshift deletion mutation in exon 19 of the EGFR gene， and the patient was given icotinib targeted therapy. After 18 months of treatment， the genetic test results showed the patient had the Exon20-T790M mutation， and the patient received oral osimertinib targeted therapy. Twelve months later， the disease progressed and CNS metastasis was found by the re-examination， and the genetic test showed the patient had the mesenchymal-epidermal transforming factor（MET） amplification，the patient received oral osimertinib combined with anlotinib targeted therapy. More than 2 months later， the re-examination results found that the disease had further progress， and the treatment plan was adjusted into osimertinib combined with savolitinib targeted therapy. After 1 month and 4 months， the re-examination results of chest CT and head MRI showed that the lung lesions and brain lesions were significantly smaller than before. Conclusion For the NSCLC brain metastases patients with EGFR-TKI resistance complicated with MET amplification after long-term targeted therapy， the combination of osimertinib and savolitinib targeted therapy can significantly control the progress of the lung and CNS disease in the short term.

Key words: Cancer，non-small cell lung, Brain metastases, Targeted therapy, Osimertinib, Savolitinib

中图分类号:

R734.2

江文利,张琳,李君瑶,许溟宇,张捷,董春玲. 奥希替尼联合赛沃替尼靶向治疗EGFR-TKI耐药伴发MET扩增的NSCLC 1例报告及文献复习[J]. 吉林大学学报(医学版), 2023, 49(3): 782-788.

Wenli JIANG,Lin ZHANG,Junyao LI,Mingyu XU,Jie ZHANG,Chunling DONG. Targeted therapy of osimertinib combined with savolitinib in NSCLC with EGFR-TKI resistance complicated with MET amplification: A case report and literature review[J]. Journal of Jilin University(Medicine Edition), 2023, 49(3): 782-788.

图/表 2

参考文献 30

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