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Osimertinib as induction therapy for oligometastatic non-small cell lung cancer with EGFR mutation: a case report
Han Wu1, Junwei Ning1, Ziming Li1
1Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background:
The role of surgery in combined modality therapy for selected stage IV oligometastatic (OM) non-small cell lung cancer (NSCLC) is still controversial. Tyrosine kinase inhibitors (TKIs) targeting epidermal growth factor receptor (EGFR) significantly improved the survival in adjuvant therapy in metastatic NSCLC but has rare evidence in inductive setting. This is the first case report about uniportal video-assisted thoracic surgery after induction therapy of TKI for OM-NSCLC.
Case Description:
A 50-year-old Chinese woman presented to hospital with headache and blurred vision and was diagnosed with an intracranial tumor. The craniotomy confirmed the metastasis from primary lung cancer. Positron emission tomography/computed tomography (PET/CT) showed the mass located in the left upper lobe and left hilar lymph node involvement. Next-generation sequencing found an EGFR mutation (exon 21 p.L858R missense), and osimertinib, a third-generation TKI, was used 80 mg per day as the induction therapy due to the EGFR mutation detected from the metastatic tumor. A favorable treatment response was observed of the lung tumor with lymph node regression, followed by uniportal thoracoscopic left upper lobectomy and systematic lymphadenectomy. The postoperative pathology evaluated both the lung lesion and lymph nodes and confirmed the OM status of this patient. No complications were observed and postoperative osimertinib 80 mg per day continued.
Conclusions:
Our case suggests that the role of surgery should be appropriately reevaluated for EGFR-mutated OM-NSCLC with the emerging development of EGFR-TKI.
Insights
Surgery may be a viable option for stage IV EGFR-mutated non-small cell lung cancer (NSCLC) oligometastasis after tyrosine kinase inhibitor (TKI) therapy. This case report details successful uniportal surgery following TKI induction for OM-NSCLC.
Area of Science:
- Oncology
- Thoracic Surgery
- Molecular Diagnostics
Background:
- The role of surgery in combined modality therapy for stage IV oligometastatic (OM) non-small cell lung cancer (NSCLC) remains debated.
- Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have improved survival in metastatic NSCLC, but their use in induction therapy is less established.
- This report presents the first case of uniportal video-assisted thoracic surgery following TKI induction therapy for OM-NSCLC.
Observation:
- A 50-year-old woman with EGFR-mutated NSCLC presented with intracranial metastasis.
- She received induction therapy with osimertinib (a third-generation EGFR-TKI) for her EGFR-mutated metastatic lung cancer.
- Positron emission tomography/computed tomography (PET/CT) revealed a primary lung mass and lymph node involvement.
Findings:
- The patient showed a favorable response to osimertinib, with regression of the lung tumor and lymph nodes.
- She underwent successful uniportal thoracoscopic left upper lobectomy and lymphadenectomy.
- Postoperative pathology confirmed oligometastatic disease, and the patient continued adjuvant osimertinib therapy without complications.
Implications:
- This case suggests that surgical intervention should be reconsidered for EGFR-mutated OM-NSCLC patients undergoing TKI therapy.
- The integration of TKIs and surgical resection may offer a promising treatment strategy.
- Further research is warranted to explore the efficacy of this combined approach in a larger cohort.
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