NEUROLOGICAL EVOLUTION OF A PATIENT WITH EGFR-MUTATED NON-SMALL CELL LUNG CANCER

Abstract

TYPE: Case Report TOPIC: Lung Cancer INTRODUCTION: EGFR mutated NSCLC benefits from targeted therapy with TKIs, however between 50 and 70% of the treated patients will progress and nearly half of these will develop resistance mutations such as T790M, for which a third-generation TKI is available. Progression to the central nervous system is sadly a common feature in NSCLC patients, it impacts their quality of life and the one of their family as well as the management of the disease. CASE PRESENTATION: A patient with IV stage adenocarcinoma of the lung progressed after 21 months of first-line anti-EGFR therapy and showed clear signs of neurological impairment, later cytologically confirmed as caused by a carcinosis on cerebrospinal fluid. Liquid biopsy detected the resistance mutation T790M and therapy was switched with the third generation TKI Osimertinib. The first instrumental re-evaluation reports a partial response, with a reduction of lesions dimensions both in the lung and at the brain-level involvement. DISCUSSION: The clinical evolution of this case study documents the efficacy in the nervous system of a third generation anti-EGFR agent, Osimertinib, in addition to the already documented efficacy in the control and management of pulmonary malignancies. Of particular note is the initial positive response after three months of therapy. The significant reduction at brain level may hopefully be a sign that the rapid evolution usually seen in this type of patient can be curbed CONCLUSIONS: This case study documents the efficacy of Osimertinib in the control and efficacy at the level of the central nervous system in an NSCLC stage IV patient. DISCLOSURE: Nothing to declare. KEYWORD: THIRD-GENERATION TKI