Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2020; 8(17): 3841-3846
Published online Sep 6, 2020. doi: 10.12998/wjcc.v8.i17.3841
Lung adenocarcinoma harboring rare epidermal growth factor receptor L858R and V834L mutations treated with icotinib: A case report
Shu-Sen Zhai, Hui Yu, Tian-Tian Gu, Yan-Xia Li, Yan Lei, Hai-Yan Zhang, Tong-Huan Zhen, Yun-Ge Gao
Shu-Sen Zhai, Yan Lei, Hai-Yan Zhang, Tong-Huan Zhen, Yun-Ge Gao, Oncology Section, PLA Strategic Support Force Characteristic Medical Center, Beijing 100101, China
Hui Yu, Tian-Tian Gu, Yan-Xia Li, Cancer Research Institute, YuceBio, Shenzhen 518000, Guangdong Province, China
Author contributions: Zhai SS, Lei Y, Zhang HY, Zhen TH and Gao YG treated the patient; Yu Hand Gu TT wrote and edited the case report; Li YX made pathological interpretation; All authors read and approved the final manuscript; all authors contributed to the study conception and design.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yun-Ge Gao, MD, PhD, Chief Doctor, Oncology Section, PLA Strategic Support Force Characteristic Medical Center, No. 9 Anxiang North Lane, Chaoyang District, Beijing 100101, China. gaoyunge306dr@163.com
Received: May 12, 2020
Peer-review started: May 12, 2020
First decision: May 21, 2020
Revised: June 2, 2020
Accepted: July 30, 2020
Article in press: July 30, 2020
Published online: September 6, 2020
Processing time: 115 Days and 6.4 Hours
Abstract
BACKGROUND

Epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitors are widely used for the treatment of non-small-cell lung cancer with EGFR mutations. However, patients with rare, even compound EGFR mutations have different responses to EGFR-tyrosine-kinase inhibitors, which bring uncertainty to clinical treatment.

CASE SUMMARY

A 45-year-old female patient presented with a 3-mo history of cough and white sputum without chest pain. Chest computed tomography revealed lung space-occupying lesions and multiple lymphadenectasis. Bronchoscopy and pathology suggested lung adenocarcinoma. Compound variation of EGFR gene (exon 21 L858R/V834L) was detected in both tissue and circulating tumor deoxyribonucleic acid samples. As a result of next-generation sequencing and her family’s wishes, the patient was given oral treatment with icotinib hydrochloride (125 mg/d, tid) from March 21, 2019 and has achieved stable disease for the last 1 year.

CONCLUSION

Non-small cell lung adenocarcinoma with EGFR L858R/V834L was treated successfully with icotinib, and it may be a new medication treatment option.

Keywords: Icotinib hydrochloride; Epidermal growth factor receptor L858R/V834L; Non-small cell lung cancer; Stable disease; Case report

Core tip: In non-small cell lung cancer, epidermal growth factor receptor (EGFR) L858R/V834L compound mutation is rare and targeted treatment of this mutation with icotinib has not been reported. In this report, the patient failed to achieve complete or partial response but achieved stable disease. The patient has been in remission for 1 year with no evidence of metastatic nodal disease, and there are signs of continuous remission. So far, the effect of this compound mutation on the efficacy of EGFR tyrosine kinase inhibitors is not clear. It is also unclear which EGFR tyrosine kinase inhibitor is most effective for this variation. This case suggests icotinib may be a possible clinical treatment.