Pulmonary pleomorphic carcinoma: A case harboring EGFR mutation treated with EGFR-TKIs

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Deciphering the Structural Effects of Activating EGFR Somatic Mutations with Molecular Dynamics Simulation
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Deciphering the Structural Effects of Activating EGFR Somatic Mutations with Molecular Dynamics Simulation

Published on: May 20, 2020

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Ken Masuda1, Takaaki Tokito1, Koichi Azuma1

  • 1Division of Respirology, Neurology, and Rheumatology, Kurume University Hospital, Kurume, Japan.

Thoracic Cancer
|April 21, 2018
PubMed

Insights

Pulmonary pleomorphic carcinoma (PPC) is rare and aggressive. EGFR-tyrosine kinase inhibitor (TKI) treatment may fail if the tumor isn't driven by the EGFR mutation, necessitating consideration of PPC.

Area of Science:

  • Oncology
  • Pulmonology
  • Pathology

Background:

  • Pulmonary pleomorphic carcinoma (PPC) is a rare primary lung cancer with poor prognosis.
  • Limited data exist on therapeutic strategies for PPC harboring EGFR mutations.
  • EGFR-tyrosine kinase inhibitors (TKIs) are standard treatments for EGFR-mutated lung adenocarcinoma.

Observation:

  • A 65-year-old woman with stage IV lung adenocarcinoma and an EGFR L858R mutation received erlotinib.
  • The patient experienced rapid disease progression and died within two weeks.
  • Postmortem analysis revealed predominantly sarcomatous components in the tumor, with EGFR mutation expression confined to adenocarcinoma areas.

Findings:

  • The patient's PPC was likely not driven by the EGFR mutation, despite its presence in adenocarcinoma components.
  • EGFR-TKI therapy was ineffective due to the tumor's heterogeneous nature and primary sarcomatous driver.

Implications:

  • Clinicians must consider PPC in cases of lung adenocarcinoma with EGFR mutations that do not respond to EGFR-TKI therapy.
  • Diagnostic biopsy specimens may not fully represent the tumor's heterogeneity, potentially leading to misdiagnosis.
  • This case highlights the importance of considering alternative diagnoses and drivers in rare lung cancers presenting with aggressive features.
Keywords:
Epidermal growth factor receptorheterogeneityoncogene addictionpleomorphic carcinoma

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