阿来替尼对化疗失败的多靶点突变的肺鳞状细胞癌显著有效:1例报告  

Alectinib-targeted Therapy in Squamous Cell Lung Carcinoma with Multiple Target Mutations after Chemotherapy Failure:a Case Report

作　　者：徐欣 孙龙华 XU Xin;SUN Long-hua(Department of Respiratory Medicine,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Jiangxi Clinical Research Center for Respiratory Diseases,Nanchang 330006,China;China-Japan Friendship Hospital Jiangxi Hospital,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院呼吸科 [2]江西省呼吸系统疾病临床研究中心 [3]中日友好医院江西医院呼吸科,南昌330006

出　　处：《南昌大学学报（医学版）》2024年第5期99-102,106,共5页Journal of Nanchang University：Medical Sciences

基　　金：国家自然科学基金资助项目(82360474,81960523)。

摘　　要：目的总结间变淋巴瘤激酶(ALK)基因融合、表皮生长因子受体(EGFR)基因突变、人表皮生长因子受体2(HER2)基因突变共存肺鳞状细胞癌(鳞癌)的有效治疗方法。方法对1例ALK基因、EGFR基因、HER2基因多基因突变的肺鳞癌患者(女,51岁,无吸烟史)的治疗过程作回顾性分析。结果患者因“咳嗽咳痰伴痰中带血2 d”就诊,影像检查、气管镜并病理活检提示为鳞癌。明确诊断为左肺鳞癌(cT3N2M0ⅢB期),左侧肺门及纵隔内淋巴结转移。患者最初接受化疗+免疫(白蛋白紫杉醇200 mg+卡铂380 mg+替雷利珠单抗200 mg)抗肿瘤治疗,因无法耐受药物毒副作用,后予以阿来替尼600 mg bid靶向治疗。靶向治疗1月后肿块明显缩小,使用阿来替尼5个周期后行胸腔镜下肺叶切除术,术后病理达到完全病理缓解;继续口服阿来替尼靶向治疗,未诉其他特殊不适。结论对于化疗失败的无吸烟史的女性鳞癌患者,有必要完善基因检测寻找靶向治疗的机会,并且以ALK融合突变为主的多基因突变的肺鳞癌患者可以从ALK抑制剂治疗中获得临床受益,也提示肺鳞癌的靶向新辅助治疗的安全性及可能性。Objective To summarize effective treatments for coexisting squamous cell lung carcinoma with anaplastic lymphoma kinase(ALK)gene fusion,epidermal growth factor receptor(EGFR)gene mutation,and human epidermal growth factor receptor 2(HER2)gene mutation.Methods A retrospective analysis of the treatment of a patient(female,51 years old,no smoking history)with squamous lung cancer with polygenic mutations in the ALK gene,EGFR gene,and HER2 gene was performed.Results The patient presented with“coughing up sputum with blood in the sputum for 2 days”,and imaging,bronchoscopy and pathologic biopsy suggested squamous carcinoma.The diagnosis was squamous carcinoma of the left lung(cT3N2M0 stage IIIB),with lymph node metastasis in the left hilar and mediastinum.The patient initially received chemotherapy plus immunotherapy(Albumin paclitaxel 200 mg+carboplatin 380 mg+Tislelizumab 200 mg)for anti-tumor treatment,and was subsequently treated with alectinib 600 mg bid for targeted therapy due to intolerance of drug toxicities.The mass was significantly reduced after 1 month of targeted therapy,and after 5 cycles of Alectinib use,the patient underwent thoracoscopic lobectomy;the postoperative pathology reached pathologic complete response(pCR);the patient continued to take oral Alectinib-targeted therapy and did not complained of any other significant symptoms.Conclusion For non-smoking female squamous cell lung cancer patients who have failed chemotherapy,our findings suggest that it is necessary to improve genetic testing to find opportunities for targeted therapy.Squamous lung cancer patients with polygenic mutations,mainly ALK fusion mutations,can benefit clinically from ALK inhibitor therapy,which also suggests the safety and possibility of targeted neoadjuvant therapy for squamous lung cancer.

关 键 词：基因突变 表皮生长因子受体基因 间变淋巴瘤激酶基因 肺鳞状细胞癌 阿来替尼 新辅助治疗 

分 类 号：R734.2[医药卫生—肿瘤]