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Case Report: Aumolertinib as Neoadjuvant Therapy for Patients With Unresectable Stage III Non-Small Cell Lung Cancer
Shao Feng1, Zhang Qiang1, Cheng Wanwan2
1Department of Thoracic Surgery, Nanjing Chest Hospital, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China.
Background:
There is no standard treatment for stage III lung cancer due to its low surgical resection rate, and improving PFS and survival of patients with III NSCLC has become an urgent challenge in clinical treatment. For EGFR mutation-positive patients, targeted therapy has the remarkable feature of high efficiency and low toxicity compared with first-line standard chemotherapy, and targeted neoadjuvant therapy needs to be further explored.
Method:
We report 3 diagnosed cases of locally advanced unresectable NSCLC with EGFR-sensitive mutations who first received 1-2 cycles of preoperative chemotherapy neoadjuvant therapy and were treated with 110 mg daily of 3rd-generation EGFR-TKI aumolertinib instead because of poor efficacy or safety intolerance.
Result:
After 2 cycles of aumolertinib treatment, all 3 patients achieved symptomatic remission and significant tumor size reduction and achieved downstaging to allow surgical treatment. No additional operative difficulties were added during the surgery. They continued to receive adjuvant therapy with the original dose of aumolertinib after surgical treatment, and no evidence of tumor recurrence was found until the most recent imaging examination. In addition, the course of neoadjuvant and adjuvant therapy was free of serious adverse effects.
Conclusion:
Perioperative treatment of these three cases of locally advanced unresectable NSCLC with EGFR-sensitive mutations with the third-generation EGFR-TKI aumolertinib showed significant efficacy and excellent safety and may be a new option for targeted therapy in the perioperative period.
Insights
Third-generation EGFR-TKI aumolertinib effectively treated unresectable non-small cell lung cancer (NSCLC) in three patients. This targeted therapy enabled tumor downstaging for surgery and showed excellent safety, offering a new perioperative option.
Area of Science:
- Oncology
- Pharmacology
- Genomics
Background:
- Stage III non-small cell lung cancer (NSCLC) lacks standard treatment due to low resectability, posing a challenge for improving progression-free survival (PFS) and overall survival.
- Epidermal growth factor receptor (EGFR) mutation-positive NSCLC patients benefit from targeted therapy's high efficacy and low toxicity compared to chemotherapy.
- Neoadjuvant targeted therapy requires further exploration for locally advanced unresectable NSCLC.
Observation:
- Three cases of locally advanced unresectable NSCLC with EGFR-sensitive mutations were treated.
- Initial neoadjuvant chemotherapy showed poor efficacy or safety intolerance in these patients.
- Aumolertinib, a third-generation EGFR-tyrosine kinase inhibitor (TKI), was administered at 110 mg daily.
Findings:
- Two cycles of aumolertinib led to symptomatic remission and significant tumor size reduction in all three patients.
- Tumor downstaging enabled surgical resection without added operative difficulties.
- Adjuvant aumolertinib therapy post-surgery showed no evidence of recurrence, with no serious adverse effects during perioperative treatment.
Implications:
- Perioperative aumolertinib demonstrates significant efficacy and excellent safety for unresectable NSCLC with EGFR-sensitive mutations.
- This targeted approach may represent a novel therapeutic strategy for the perioperative management of such patients.
- Further clinical investigation into third-generation EGFR-TKIs in the perioperative setting is warranted.
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