Hu XY, Fei YC, Zhou WC, Zhu JM, Lv DL. Triple administration of osimertinib followed by chemotherapy for advanced lung adenocarcinoma: A case report. World J Clin Cases 2021; 9(11): 2627-2633 [PMID: 33889629 DOI: 10.12998/wjcc.v9.i11.2627]
Corresponding Author of This Article
Dong-Lai Lv, BPhty, DVSc, MD, Chief Doctor, Department of Clinical Oncology, 901 Hospital of Joint Logistic Support Force, No. 424 West Changjiang Road, Shushan District, Hefei 230031, Anhui Province, China. lvxunhuan@163.com
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Xu-Yan Hu, Department of Clinical Medicine, Bengbu Medical College, Bengbu 233030, Anhui Province, China
Yu-Cheng Fei, Dong-Lai Lv, Department of Clinical Oncology, 901 Hospital of Joint Logistics Support Force of People Liberation Army, Hefei 230031, Anhui Province, China
Wen-Chao Zhou, Intelligent Pathology Institute, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230036, Anhui Province, China
Jin-Miao Zhu, Department of Pharmaceutical Engineering, Hefei Normal University, Hefei 230601, Anhui Province, China
Author contributions: Hu XY and Fei YC were major contributors to the writing of the manuscript; Zhou WC revised the manuscript; Zhu JM interpreted the pharmacological findings; Lv DL treated the patient; all authors approved the manuscript; Hu XY and Fei YC are co-first authors.
Supported byThe Natural Science Foundation Project of Anhui Province, No. 1808085MH267; and Key Research and Development Project of Anhui Province, No. 202004a07020020.
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 no competing interests.
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: Dong-Lai Lv, BPhty, DVSc, MD, Chief Doctor, Department of Clinical Oncology, 901 Hospital of Joint Logistic Support Force, No. 424 West Changjiang Road, Shushan District, Hefei 230031, Anhui Province, China. lvxunhuan@163.com
Received: December 7, 2020 Peer-review started: December 7, 2020 First decision: December 30, 2020 Revised: January 11, 2021 Accepted: January 27, 2021 Article in press: January 27, 2021 Published online: April 16, 2021 Processing time: 116 Days and 10.7 Hours
Abstract
BACKGROUND
Osimertinib is the recommended first-line treatment for adult patients with epidermal growth factor receptor (EGFR) mutation positive advanced or metastatic non-small cell lung cancer (NSCLC). However, primary or acquired resistance to EGFR-tyrosine kinase inhibitors (EGFR-TKIs) seems inevitable, and when drug-resistance occurs during treatment with osimertinib, the standard of care is to discontinue the TKI.
CASE SUMMARY
A 57-year-old female patient with lung adenocarcinoma presented with an irritating cough accompanied by chest distress of one month duration. An enhanced head magnetic resonance imaging scan showed brain metastases. An EGFR mutation (exon 21 L858R) was detected in pleural fluid. The patient was treated with oral osimertinib (80 mg once daily) from January 2018 but developed progressive disease on December 2018. She was then successfully treated with re-challenge and tri-challenge with osimertinib (80 mg once daily) by resensitization chemotherapy twice after the occurrence of drug-resistance to osimertinib, and to date has survived for 31 mo.
CONCLUSION
This case may provide some selective therapeutic options for NSCLC patients with acquired drug-resistance who were previously controlled on osimertinib treatment.
Core Tip: Osimertinib is the first-line recommended treatment for adult patients with epidermal growth factor receptor mutation positive advanced or metastatic non-small cell lung cancer. Once drug-resistance occurs in osimertinib, the standard of care is to discontinue the tyrosine kinase inhibitor. To the best of our knowledge, this is the first report of successful re-challenge and tri-challenge with osimertinib administered via multiple re-sensitization chemotherapy protocols. This case provides a useful reference for prolonging the efficacy of osimertinib.