晚期肺腺癌靶向耐药后小细胞癌转化2例并文献复习  

Two Cases of TKI-resistant Small Cell Lung Cancer Transformation in Advanced Adenocarcinoma and Literature Review

作　　者：吴洁琼 任敦强[1] 易冰倩 毕焕焕 邵艳梅[1] 王红梅[1] Jieqiong WU;Dunqiang REN;Bingqian YI;Huanhuan BI;Yanmei SHAO;Hongmei WANG(Department of Respiratory and Critical Care Medcine,The Affiliated Hospital of Qingdao University;School of Medicine,Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院呼吸与危重症医学科,青岛266000 [2]青岛大学医学部

出　　处：《中国肺癌杂志》2022年第11期828-834,共7页Chinese Journal of Lung Cancer

摘　　要：具有表皮生长因子受体(epidermal growth factor receptor,EGFR)敏感突变的晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者应用EGFR酪氨酸激酶抑制剂(EGFR-tyrosine kinase inhibitors,EGFR-TKIs)治疗可取得良好的疾病控制,但不可避免会产生耐药。其中3%-10%左右的耐药机制为小细胞癌转化。本文报道2例IV期肺腺癌存在EGFR突变、经EGFR-TKIs治疗后疾病得到控制的病例。病例1发生小细胞癌转化前的无进展生存期(progression-free survival,PFS)为16个月,病例2发生小细胞癌转化前的PFS为24个月。疾病进展后再次活检提示小细胞癌转化。经后续治疗再次稳定,病例1发生小细胞癌转化后的PFS为6个月,总生存期(overall survival,OS)暂未出现,病例2发生小细胞癌转化后的PFS为8个月,OS为36个月,显著延长了患者生存。同时对此类耐药突变进行文献复习。对于晚期NSCLC存在敏感突变的患者,经EGFR-TKIs治疗耐药后进行二次组织病理检测,根据不同耐药机制选择后续治疗对疾病全程管理十分必要。Treatment of advanced non-small cell lung cancer(NSCLC) patients with epidermal growth factor receptor(EGFR) mutation with EGFR-tyrosine kinase inhibitors(EGFR-TKIs) can achieve good disease control,but it will inevitably produce drug resistance.About 3 %-10% of the resistance mechanism is small cell transformation.Two cases of stage Ⅳ lung adenocarcinoma with EGFR mutation were reported and the disease was controlled after EGFR-TKIs treatment.In case 1,progression-free survival(PFS) before small cell carcinoma transformation was 16 months,and in case 2,PFS before small cell carcinoma transformation was 24 months.Subsequent biopsy after disease progression indicated a shift to small cell lung cancer.Case 1 PFS after small cell carcinoma transformation was 6 months,and case 2 PFS after small cell carcinoma transformation was 8 months,and overall survival(OS) was 36 months,which significantly prolonged the patient’s survival.At the same time,the literature of such drug resistance mutations was reviewed.For patients with advanced NSCLC with sensitive mutations,it is necessary to conduct secondary histopathological tests after TKIs treatment resistance,and select subsequent treatment according to different resistance mechanisms for the whole course of disease management.

关 键 词：小细胞癌转化 EGFR基因突变 RB1 TP53 

分 类 号：R734.2[医药卫生—肿瘤]