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Plasticity in EGFR-mutant NSCLC: SCLC transformation and subsequent re-emergence: case report
Farzaneh Atashrazm1,2, Gabrielle Bradshaw3, Jonathan Clark3
1Department of Medical Oncology, Austin Health, Melbourne, VIC, Australia.
Abstract:
Small cell lung cancer (SCLC) transformation is a recognized resistance mechanism in EGFR-mutated non-small cell lung cancer (NSCLC) following treatment with tyrosine kinase inhibitors (TKIs). However, subsequent re-emergence of adenocarcinoma following SCLC transformation is exceedingly rare and remains poorly understood. We report a case of metastatic EGFR L858R-mutant lung adenocarcinoma that underwent transformation to small cell lung cancer (SCLC) and subsequently re-emerged as adenocarcinoma with a distinct and complex resistance profile. This case highlights the extreme lineage plasticity of EGFR-mutant NSCLC and underscores the necessity of serial biopsies to identify evolving distinct clonal populations and guide therapy.
Insights
Small cell lung cancer (SCLC) transformation can occur in EGFR-mutated non-small cell lung cancer (NSCLC) treated with TKIs. This rare case shows SCLC re-emerging as adenocarcinoma, highlighting lineage plasticity and the need for serial biopsies.
Area of Science:
- Oncology
- Molecular Biology
- Cancer Research
Background:
- EGFR-mutated non-small cell lung cancer (NSCLC) can develop resistance to tyrosine kinase inhibitors (TKIs) through small cell lung cancer (SCLC) transformation.
- The subsequent re-emergence of adenocarcinoma after SCLC transformation is an exceptionally rare phenomenon.
