Cílená léčba bronchioloalveolárního plicního adenokarcinomu inhibitory tyrozinkinázové aktivity EGFR: kazuistika klinicky promptní a výrazné odpovědi a přehled literatury
| Title in English | EGFR Tyrosine Kinase Inhibitors as a Targeted Th erapy for Bronchioloalveolar Carcinoma of the Lung: a Case Report of a Clinically Prompt and Intensive Response and Literature Review |
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| Authors | |
| Year of publication | 2010 |
| Type | Article in Periodical |
| Magazine / Source | Klinická onkologie |
| MU Faculty or unit | |
| Citation | |
| Web | http://www.linkos.cz/odbornici/vzdelavani/4_10/04.pdf |
| Field | Oncology and hematology |
| Keywords | lung cancer;bronchioloalveolar carcinoma;EGFR gene;K-ras gene;erlotinib;gefitinib;targeted therapy;prediction |
| Description | Introduction: Bronchioloalveolar carcinoma (BAC) is an adenocarcinoma belonging to non-small cell lung carcinomas (NSCLC) that, in addition to its morphology and endobronchial spread, presents with certain specifi c clinical characteristics: greater incidence in women, non-smokers and younger patients, presence of malignant bronchorrhea and lower susceptibility to conventional cytostatic therapies in comparison to other subtypes of NSCLC. On the other hand, nonmucinous type of BAC may show better therapeutic response to targeted therapy with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKI) erlotinib or gefi tinib, as it is 5 times more frequently a carrier of EGFR gene mutations compared to conventional lung adenocarcinomas. Case description: We present a case of a 41 years old man, non-smoker for the last 5 years, who was diagnosed with a pneumonic form of nonmucinous bronchioloalveolar carcinoma. Metastases to regional and distant lymph nodes and massive involvement of skeleton with infi ltrations in the bone marrow were present at the diagnosis. During the fi rst line palliative chemotherapy with combination regimen of carboplatin and paclitaxel, the disease progressed signifi cantly and the patients condition deteriorated (performance status (PS) 3, severe dyspnoea at rest, malignant bronchorrhea). Subsequently, administration of erlotinib was initiated based on a series of case studies describing good response of BAC to treatment with EGFR TKI. An evident improvement of the patients condition was observed as early as 4 days of administration, together with regression of peripheral lymphadenopathy. Nearly complete disappearance of pulmonary infi ltrates was observed after 30 days of therapy, with the patient becoming asymptomatic, PS 0. Molecular genetics confi rmed the tumour phenotype to be highly responsive to EGFR TKI therapy. The tumour contained EGFR mutation in exon 19 (in-frame L747-753insS deletion) and wild-type K-ras. Disease relapse in the liver occurred 6 months later confi rming disease progression. Further treatment remained ineff ective despite brief stabilisations of liver enzyme progression following repeated administration of pemetrexed and gefi tinib. The patient died 12 months after the diagnosis. Conclusions: Our case confi rms the importance of targeted therapy when treating tumours of an appropriate phenotype. Such treatment may have prompt and intensive eff ect that may reverse the course of the disease even in patients with poor overall health status. |