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09 April 2024 : Case report  Japan

[In Press] Simultaneous Acquisition of T790M Mutation and SCLC Transformation during Targeted Therapy in EGFR-Mutated Lung Adenocarcinoma: A Rare Case Report

Unusual clinical course

Tatsuya Yazaki12AEF, Masanobu Kimoto2E, Ayumi Minagawa2E, Takashi Maruno2E, Miwa Yamanaka12E, Kei Sonehara1EF, Mineyuki Hama2E, Toshitsugu Nakamura3E, Shintaro Kanda4E, Masayuki Hanaoka1E, Tsutomu Hachiya2EF

DOI: 10.12659/AJCR.943466

Am J Case Rep In Press; DOI: 10.12659/AJCR.943466  

Available online: 2024-04-09, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule


Various resistance mechanisms of the epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) have been reported, and approximately half of the cases show a T790M point mutation as resistance to EGFR-TKI. In addition, 3-14% of cases of non-small cell lung cancer transform into small cell lung carcinoma (SCLC) during treatment. However, there are few reported cases in which 2 mechanisms of resistance have been observed simultaneously. This report describes a 66-year-old man with initial presentation of stage IIA right-sided lung adenocarcinoma with EGFR gene exon 21 L858R mutation and 3 years of stable disease. During treatment with erlotinib, the patient developed SCLC and adenocarcinoma with EGFR exon 21 L858R and exon 20 T790M mutation.
A 66-year-old man underwent right pneumonectomy plus nodal dissection 2a for right hilar lung cancer and was diagnosed with an EGFR exon21 L858R mutated lung adenocarcinoma. Three years later, pleural dissemination was observed in the right chest wall. Although erlotinib was continued for 52 months, new metastases to the right ribs were detected. Chest wall tumor resection was performed. Based on the World Health Organization classification, the patient was diagnosed with combined SCLC, with EGFR exon21 L858R and exon20 T790M mutation. The patient received 4 cycles of carboplatin plus etoposide, 14 cycles of amrubicin, and 2 cycles of irinotecan. Chemotherapy continued for 25 months.
Long-term survival was achieved by chemotherapy after transformation. Since EGFR mutation-positive lung cancer shows a variety of acquired resistances, it is important to consider the treatment strategy of performing re-biopsy.

Keywords: Biopsy; Small Cell Lung Carcinoma; Adenocarcinoma of Lung; EGFR Tyrosine Kinase Inhibitor 324674

In Press

Case report  Iran

Simultaneous L1-2 Bulged Disc and Mobile Spinal Schwannoma Causing Cauda Equina Syndrome: A Rare Case Report

Am J Case Rep In Press; DOI: 10.12659/AJCR.942717  


Case report  Thailand

Severe Complications of Uterine Dehiscence Post-Lower Segment Cesarean Section: A Case Report Emphasizing t...

Am J Case Rep In Press; DOI: 10.12659/AJCR.943027  

Case report  USA

A Prefixed Four-Trunk Brachial Plexus with Anomalous Anatomy of All Subsequent Divisions, Cords, and Termin...

Am J Case Rep In Press; DOI: 10.12659/AJCR.943866  

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Am J Case Rep In Press; DOI: 10.12659/AJCR.942948  

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923