Zhang L, Wang J, Cui LZ, Wang K, Yuan MM, Chen RR, Zhang LJ. Successful treatment of refractory lung adenocarcinoma harboring a germline BRCA2 mutation with olaparib: A case report. World J Clin Cases 2021; 9(25): 7498-7503 [PMID: 34616818 DOI: 10.12998/wjcc.v9.i25.7498]
Corresponding Author of This Article
Li-Jiao Zhang, MM, Chief Physician, Professor, Department of Cadre Health, Shanxi Provincial Cancer Hospital, No. 3 Employee Xincun, Xinghualing District, Taiyuan 030013, Shanxi Province, China. zljsx66@126.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/
World J Clin Cases. Sep 6, 2021; 9(25): 7498-7503 Published online Sep 6, 2021. doi: 10.12998/wjcc.v9.i25.7498
Successful treatment of refractory lung adenocarcinoma harboring a germline BRCA2 mutation with olaparib: A case report
Li Zhang, Jing Wang, Ling-Zhi Cui, Kai Wang, Ming-Ming Yuan, Rong-Rong Chen, Li-Jiao Zhang
Li Zhang, Jing Wang, Ling-Zhi Cui, Li-Jiao Zhang, Department of Cadre Health, Shanxi Provincial Cancer Hospital, Taiyuan 030013, Shanxi Province, China
Kai Wang, Ming-Ming Yuan, Rong-Rong Chen, Department of Medicine, Geneplus-Beijing, Beijing 102206, China
Author contributions: Zhang L reviewed and searched the literature, analyzed and interpreted the imaging findings, drafted the manuscript, and gave critical comments; Wang J and Cui LZ collected the clinical data; Wang K and Yuan MM reviewed the literature; Chen RR gave critical comments; Zhang LJ contributed to the revision of the manuscript; all authors approved the version to be submitted.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: Wang K, Yuan MM, and Chen RR are current employees of Geneplus-Beijing. The other authors have no conflicts of interest to declare.
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: Li-Jiao Zhang, MM, Chief Physician, Professor, Department of Cadre Health, Shanxi Provincial Cancer Hospital, No. 3 Employee Xincun, Xinghualing District, Taiyuan 030013, Shanxi Province, China. zljsx66@126.com
Received: February 2, 2021 Peer-review started: February 2, 2021 First decision: May 11, 2021 Revised: May 24, 2021 Accepted: July 19, 2021 Article in press: July 19, 2021 Published online: September 6, 2021 Processing time: 210 Days and 1.8 Hours
Abstract
BACKGROUND
In recent years, targeted therapy and immunotherapy have become important treatment strategies for patients with non-small cell lung cancer (NSCLC). However, the clinical evidence for successful off-label use of targeted drugs for patients with NSCLC following progression on multiple lines of treatment is still lacking.
CASE SUMMARY
We describe a 62-year-old male patient with a right lung adenocarcinoma who harbored an EGFR exon 19 deletion mutation. He received gefitinib combined with six cycles of vinorelbine, cisplatin, and recombinant human endostatin as the first-line therapy. Then gefitinib was administered in combination with recombinant human endostatin as maintenance therapy, resulting in a progression-free survival (PFS) of 14 mo. Chemoradiotherapy was added following progression (enlarged brain metastases) on maintenance treatment. Unfortunately, the brain lesions were highly refractory and progressed again after 15 mo, at which time next-generation sequencing (NGS) of 1021 cancer-related genes was performed using peripheral blood to identify potential actionable mutations. NGS revealed that the patient harbored a BRCA2 germline mutation, the EGFR exon 19 deletion mutation disappeared, and no additional targetable genetic variant was detected. Therefore, the patient received olaparib combined with gefitinib and recombinant human endostatin, with a rapid and long-lasting clinical response (PFS = 13.5 mo).
CONCLUSION
This is a rare case of lung adenocarcinoma in a patient with a BRCA2 germline mutation who had long-term benefit from olaparib combination treatment, suggesting that NGS-based genetic testing may render the possibility of long-term survival in NSCLC patients after disease progression.
Core Tip: The clinical evidence for successful off-label use of targeted drugs for lung adenocarcinoma patients following progression on multiple lines of treatment is still lacking now. Herein, we describe the identification of a germline BRCA2 mutation in a lung adenocarcinoma patient. The patient had multiple refractory brain metastases and received olaparib combined with gefitinib and recombinant human endostatin following progression on multiple lines of treatment, with a progression-free survival of 13.5 mo. This case provides unequivocal clinical evidence for the off-label use of olaparib in lung adenocarcinoma patients with a BRCA mutation after disease progression.
