P3.13-30 Driver Mutation in Heavy Smoker Patient with Squamous Cell Carcinoma Metastatic Lung Cancer: Case Report

Abstract

Nowadays, guidelines recommend to assess the presence of a driver mutation in tumors that contains an element of adenocarcinoma regardless of the clinical characteristics of the patient or squamous cell carcinoma in a patient that never smoked. We reported a clinical case of a pacient that had a squamous cell carcinoma with a driver mutation in EGFR, despite the fact that he was a heavy smoker. the case occured in our service in the northeast of Brazil. Woman, 63 years old, current smoking, presented in a public health service in Brazil with history of cought and dyspneia 3 months earlier. In the investigation, CTS showed mass hilar in the right lung and enlarged lymphonodes in the mediastinum IPSI and contralateral, but there was no evidence of secondary lesios in other organs. She was submitted to a core biopsy CT guided that confirmed squamous cell carcinoma. The planned treatment was radiotherapy and concomitant chemotherapy. As in our service the time to start the radiotheraphy is about 3 months, we started a platin based chemotherapy and made sequencial radiotherapy. After that, she was submitted to new CTS that showed partial response in the lung and lymphnodes, but there was evidence of bone metastatis in the sacrum and left iliac. In our service, there was a trial in which all patients diagnosed with lung cancer had it’s tissue avaliated for driver mutation, and we received the results with a driver mutation in exon 19 of EGFR. So, we started a treatment with Erlotinib with a great response and, now, after 9 months, it’s still responding. This case represent a rare case of a squamous cell carcinoma with a driver mutation in a current smoking, and maybe justified by the fact that the tumor had an adenosquamous component. If the patient wasn’t tested for driver mutations, she would never receive an target therapy. Thus, maybe we should assessed all non small lung cancers for the driver mutations.