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Rapidly progressive squamous cell lung cancer with MET exon 14 skipping mutation metastasized to atypical bone sites
Background:
The mesenchymal-epithelial transition factor (MET) exon 14 skipping mutation has recently emerged as a driver gene in non-small cell lung cancer (NSCLC) in clinical practice. Clinical trials of several MET inhibitors have shown the effectiveness of MET inhibitors in NSCLC patients with MET exon 14 skipping mutation. To the best of our knowledge, however, there was no patient with sole MET exon 14 skipping mutation who progressed rapidly and had a poor prognosis.
Case:
A 61-year-old man presented with pain in the dorsum of the left foot and in the left elbow. Chest CT revealed a mass in the right lower lobe of the lung, and FDG-PET showed metastases in the ribs, thoracic vertebra, left elbow, and left metacarpal bone. Corrected calcium level was elevated up to 14.1mg/dL. The histopathology of the transbronchial bio-psy specimen was morphologically consistent with squamous cell carcinoma. MET exon 14 skipping mutation was positive in Oncomine Dx Target Test Multi-CDx system. Within a few weeks of admission, the patients respiratory condition rapidly deteriorated carcinomatous lymphangiosis and died of acute respiratory failure one month after admission. In this patient, bone metastases to atypical sites and hypercalcemia were also observed.
Conclusion:
Chest physicians should be noted that there might be rapidly progressive fatal patients among those with MET exon 14 skipping mutations.
Insights
A rare case of non-small cell lung cancer (NSCLC) with MET exon 14 skipping mutation showed rapid progression and poor prognosis. This highlights the need for vigilance in patients with this specific genetic alteration.
Area of Science:
- Oncology
- Genetics
- Pulmonology
Background:
- Mesenchymal-epithelial transition factor (MET) exon 14 skipping mutations are recognized drivers in non-small cell lung cancer (NSCLC).
- MET inhibitors demonstrate efficacy in NSCLC patients with this mutation.
- Rapidly progressive disease with poor prognosis in sole MET exon 14 skipping mutation cases is not well-documented.
Observation:
- A 61-year-old male presented with advanced NSCLC, including bone metastases and hypercalcemia.
- Histopathology confirmed squamous cell carcinoma with a positive MET exon 14 skipping mutation.
- The patient experienced rapid clinical deterioration, carcinomatous lymphangiosis, and acute respiratory failure.
Findings:
- The patient with MET exon 14 skipping mutation exhibited rapid progression and a fatal outcome.
- Atypical bone metastases and hypercalcemia were noted in this case.
- This case represents a rare instance of poor prognosis despite the identified driver mutation.
Implications:
- Chest physicians must consider the possibility of rapid, fatal progression in NSCLC patients with MET exon 14 skipping mutations.
- This case underscores the importance of recognizing diverse clinical presentations and prognoses associated with specific oncogenic drivers.
- Further research may be warranted to understand factors contributing to aggressive disease in a subset of MET-altered NSCLC patients.
