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Marked response to nab-paclitaxel in EGFR mutated lung neuroendocrine carcinoma: A case report
Jin-Yan Liang1, Fan Tong, Fei-Fei Gu
1Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Rationale:
Lung cancer is the leading cause of cancer-related death in the world. Tyrosine kinase inhibitors (TKIs), which target mutated epidermal growth factor receptor (EGFR), have been the first-line treatment of late-stage lung adenocarcinoma harboring EGFR mutation. EGFR mutations are mostly identified in lung adenocarcinoma. However, it is rarely seen in lung neuroendocrine carcinoma, and treatment strategies remain under reported.
Patient Concerns:
Here, we describe a 54-year-old Chinese man diagnosed with lung adenocarcinoma (cT4N3M1b, stage IV) with neuroendocrine differentiation and L858R mutation on exon 21. He developed progressive disease in liver 4 months later, and the biopsy of liver metastases showed neuroendocrine carcinoma maintained the same EGFR mutation.
Diagnoses:
Lung adenocarcinoma and neuroendocrine carcinoma were identified by biopsy.
Interventions:
After a combined treatment with nab-paclitaxel and erlotinib, the patient achieved partial remission.
Outcomes:
The patient's overall survival was 27 months.
Lessons:
This case highlights that EGFR mutated lung neuroendocrine carcinoma is not responsive to single-agent EGFR-TKI. However, combined application with nab-paclitaxel can improve its efficacy and prolong the patient's survival.
Insights
EGFR-mutated lung neuroendocrine carcinoma requires combination therapy. Nab-paclitaxel plus erlotinib improved outcomes in a stage IV lung cancer patient, demonstrating potential for improved efficacy and survival.
Area of Science:
- Oncology
- Medical Genetics
- Thoracic Surgery
Background:
- Lung cancer remains a leading global cause of cancer mortality.
- Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are standard first-line therapy for advanced EGFR-mutated lung adenocarcinoma.
- EGFR mutations are uncommon in lung neuroendocrine carcinoma, with limited reported treatment strategies.
Observation:
- A 54-year-old man with stage IV lung adenocarcinoma and neuroendocrine differentiation harbored an EGFR L858R mutation.
- The patient developed liver metastases that, upon biopsy, confirmed neuroendocrine carcinoma retaining the EGFR mutation.
- Initial diagnosis was lung adenocarcinoma with neuroendocrine differentiation, confirmed by biopsy.
Findings:
- Single-agent EGFR-TKI therapy was ineffective for the EGFR-mutated lung neuroendocrine carcinoma.
- Combined treatment with nab-paclitaxel and erlotinib resulted in partial remission.
- The patient achieved an overall survival of 27 months.
Implications:
- EGFR-mutated lung neuroendocrine carcinoma may not respond to monotherapy with EGFR-TKIs.
- Combination therapy, including nab-paclitaxel with EGFR-TKIs, can enhance treatment efficacy.
- This approach holds promise for prolonging survival in patients with this rare lung cancer subtype.
