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Effective treatment with icotinib in advanced lung adenocarcinoma harboring rare EGFR mutation G719A/L833V: A case
Bin Zhou1, Yanan Wang2, Haijiang Liao1
1Department of Thoracic Surgery, Affiliated Hospital of Hebei University, Baoding, China.
Rationale:
Mutations in epidermal growth factor receptor (EGFR) play critical roles in the pathogenesis of non-small cell lung cancer (NSCLC), and they are highly associated with sensitivity to tyrosine kinase inhibitors. Targeted therapies are approved for patients with "classical" mutations and a small number of other mutations. However, patients with rare, even double EGFR mutations have different responses to EGFR tyrosine kinase inhibitor, which brings uncertainty to clinical practice.
Patient Concerns:
A 74-year-old woman, never-smoker, was presented with chest pain. Chest computed tomography scan showed a big lesion in the right upper lobe with mediastinal lymph nodes metastases. Fine-needle biopsy and pathology suggested lung adenocarcinoma. A rare G719A/L833V double mutation of EGFR was detected in both tissue and plasma samples by next-generation sequencing.Interventions and outcomes:Icotinib was used as first-line therapy and showed good efficacy. Partial response was achieved, and the progression-free survival was 8 months.
Lessons:
This is the first report of the icotinib treatment achieving long-lasting and stable disease control in an NSCLC patient with EGFR G719A/L833V mutation. Icotinib could be a first-line treatment option in NSCLC patients harboring EGFR G719A/L833V mutation.
Insights
This study reports a rare double mutation in epidermal growth factor receptor (EGFR) in non-small cell lung cancer (NSCLC). Icotinib demonstrated efficacy as a first-line treatment for this specific EGFR mutation.
Area of Science:
- Oncology
- Molecular Biology
Background:
- Epidermal growth factor receptor (EGFR) mutations are key drivers in non-small cell lung cancer (NSCLC) pathogenesis.
- EGFR mutations influence sensitivity to tyrosine kinase inhibitors (TKIs).
- Approved targeted therapies primarily address common EGFR mutations, leaving rare mutations with uncertain treatment outcomes.
Observation:
- A never-smoker 74-year-old female presented with lung adenocarcinoma and mediastinal lymph node metastases.
- Next-generation sequencing identified a rare G719A/L833V double mutation in EGFR in both tissue and plasma samples.
- The patient received icotinib as first-line therapy.
Findings:
- Icotinib treatment resulted in a partial response and 8 months of progression-free survival.
- This represents the first documented case of icotinib achieving stable disease control in NSCLC with the EGFR G719A/L833V mutation.
- The patient, a never-smoker, showed good tolerance and efficacy to icotinib.
Implications:
- Icotinib may be a viable first-line treatment option for NSCLC patients with the rare EGFR G719A/L833V mutation.
- This case highlights the importance of comprehensive genomic profiling for identifying rare mutations.
- Further research is warranted to explore the efficacy of icotinib in broader NSCLC populations with uncommon EGFR alterations.
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