Sequential T790M mutation testing and changes in the therapeutic approach after 2 lines of chemotherapy – clinical case
DOI:
https://doi.org/10.32932/gecp.2021.07.015Keywords:
Carcinoma, non-small-cell lung/drug therapy, carcinoma, non-small-cell lung/genetics, carcinoma, non-small-cell lung/pathology, EGFR mutation, lung neoplasms/genetics, mutation/genetics, rebiopsy, targeted therapy, TKI -resistance, T790M -mutationAbstract
The EGFR mutation is identified in 10-50% of patients with non-small cell lung cancer (NSCLC). After first-line therapy, with 1st or 2nd line tyrosinacinase (TKI) inhibitors, in patients with NSCLC and a sensitizing EGFR mutation the most frequent mechanism of resistance is the acquisition of a T790M mutation, in 50-70%. We present the clinical case of a woman with NSCLC, cT2bN1M1b, stage IV with cerebral and adrenal metastasis at diagnosis and EGFR mutation. She underwent holocranial radiotherapy and treatment with erlotinib. Detection of T790M mutation after 2 chemotherapy regimens, with previous negative result on both liquid and histological biopsy for the detection ofT790M mutation. Eight years after diagnosis, she is functionally autonomous, asymptomatic, under therapy with osimertinib. This case illustrates the importance of knowledge of the resistance mechanism in patients with NSCLC and EGFR mutations, and the role of sequential rebiopsies.Downloads
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