Abstract: Objective: To report a case of lung adenocarcinoma of stage Ⅳ with epidermal growth factor receptor(EGFR) mutation treated by Erlotinib HCL Tablets and chemotherapy combined with bevacizumab after drug resistance, and to review the related literatures. Methods: A female patient without smoking history was diagnosed with lung adenocarcinoma (stagecT3N2M1 Ⅳ) with metastatic lesions in liver and bones by chest CT, lung puncture biopsy,and whole-body PET-CT. EGFR gene test reported mutation (19 del). Through treatment of overall survival, pemetrexed disodium for injection plus carboplatin injection, gemcitabine hydrochloride for injection plus cisplatin injection, paclitaxel for injection(albumin bound) single and with bevacizumab; the overall survival(OS) was assessed as 32 months. And the period of Erlotinib HCL Tablets showed 10 months of progressive-free survival(PFS). However, due to the metastatic lesions that suppressed biliary system in liver, hyperbilirubinemia emerged(total bilirubin 304 μmol·L^-1, direct bilirubin 193 μmol·L^-1). Bevacizumab was adopted and the syndrome relieved(total bilirubin 70 μmol·L^-1, direct bilirubin 35 μmol·L^-1), yielding three months of PFS. But the bilirubin level upgraded with total bilirubin of 908 μmol·L^-1. The patient died because of hyperbilirubinemia. Results: 10-month PFS occupied 1/3 of OS was acquired in the patients with EGFR-mutated lung adenocarcinoma(stage Ⅳ) after treated with Erlotinib HCL Tablets. Chemotherapy combined with bevacizumab acquired 3 months of PFS after hyperbilirubinemia emerged with drug resistance and multi-lines of chemotherapy. Conclusion: EGFR-TKIs are effective in treatment of lung adenocarcinoma with EGFR mutation; bevacizumab can inhibit the formation of vessels by targeting on VEGF under the circumstance of multiple drug resistance. Therefore, chemotherapy combined with bevacizumab can be used as the fifth-line of therapy in dealing with the hyperbilirubinemia induced by lung adenocarcinoma with liver metastasis.

Key words: epidermal growth factor receptor, lung neoplasms, Erlotinib HCL Tablets, bevacizumab, bilirubin