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Published on: November 22, 2021
First-Line Osimertinib for EGFR-Mutated Squamous Cell Lung Carcinoma: A Case Report
Yugo Matsumura1, Seiya Ichihara1, Kaori Nii1
1Department of Respiratory Medicine, National Hospital Organization Kochi Hospital, Kochi, Japan.
Background:
Epidermal growth factor receptor (EGFR) mutations in squamous cell lung carcinoma are rare. EGFR-tyrosine kinase inhibitors are generally less effective for EGFR-mutated squamous cell lung carcinoma. We herein present a case of EGFR-mutated squamous cell lung carcinoma that responded to osimertinib.
Case:
A 75-year-old woman with bloody sputum and left back pain was referred to NHO Kochi Hospital. A mass was observed in the left lower lobe on chest CT. Squamous cell lung carcinoma, cT4N1M1b (adrenal metastasis) stage IVA, was diagnosed based on the findings of a CT-guided percutaneous lung biopsy and a CT scan revealing right adrenal metastasis. The primary tumor was subjected to a genomic analysis with the AmoyDx Pan Lung Cancer PCR panel, which revealed an EGFR mutation (exon 21 L858R). The PD-L1 tumor proportion score was 95%. Osimertinib was initiated as first-line targeted therapy. Tumor shrinkage was observed and maintained over 9 months of treatment.
Conclusion:
We encountered a rare EGFR-mutated squamous cell lung carcinoma that responded well to osimertinib. Osimertinib may be an option for the treatment of patients with EGFR-mutated squamous cell lung carcinoma.
Insights
A rare case of squamous cell lung carcinoma with an epidermal growth factor receptor (EGFR) mutation showed a positive response to osimertinib treatment. This finding suggests osimertinib may be a viable option for this specific patient group.
Area of Science:
- Oncology
- Genomics
- Thoracic Surgery
Background:
- Squamous cell lung carcinoma (SCLC) rarely harbors epidermal growth factor receptor (EGFR) mutations.
- EGFR-tyrosine kinase inhibitors (TKIs) typically demonstrate limited efficacy in EGFR-mutated SCLC.
- This case highlights a deviation from the general trend, presenting a responsive EGFR-mutated SCLC.
Observation:
- A 75-year-old female presented with hemoptysis and back pain, diagnosed with stage IVA SCLC with adrenal metastasis.
- Genomic analysis revealed an EGFR exon 21 L858R mutation in the primary tumor.
- The tumor exhibited a high PD-L1 expression (95%).
Findings:
- First-line treatment with osimertinib resulted in significant tumor shrinkage.
- The therapeutic response was maintained for over 9 months.
- This indicates a notable sensitivity to osimertinib in this rare SCLC subtype.
Implications:
- Osimertinib demonstrates potential efficacy in a subset of EGFR-mutated SCLC patients.
- This case expands the therapeutic considerations for SCLC beyond standard treatment protocols.
- Further investigation into EGFR-mutated SCLC response to targeted therapies is warranted.
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