THE IMPORTANCE OF GENOTYPING EGFR, ALK, AND PDL1 MUTATIONS IN THE THERAPEUTIC DECISION IN PATIENTS WITH PULMONARY ADENOCARCINOMA

Abstract

TYPE: Abstract TOPIC: Lung Cancer PURPOSE: The importance of detecting mutations in the EGFR gene, ALK and PDL1 in guiding the therapeutic strategy in patients with pulmonary Adenocarcinoma METHODS: Case of a patient aged 60 years,smoker ( 30 packs per year), with professional exposure, who is under monitoring for COPD, who for 2 months presents dyspnea at medium effort, intermittent productive cough, weight loss,physical asthenia, SpO2 :95 % (a.a). Important systemic inflammatory syndrome and increased level of d-dimer, with suspicion of pulmonary thrombembolism, possibly due to the presence of a tumor. The thoracic CT scan reveals the presence of a left mediastinum-pulmonary tumor of 40/70/65 mm, minimal bilateral pleurisy,mediastinal adenopathies. Fibrobronchoscopy did not have a conclusive result. RESULTS: The patient is delaying the diagnosis and the initiation of treatment by not going on further with the investigations. After 1 year, he suffers a bilobectomy of the middle and the right upper lobe. Additional tests are performed in order to detect and genotyping the activating mutations in the EGFR gene: no activating mutations were found on EGFR gene. ALK is negative so the status of the ALK gene is not favorable for treatment with ALK inhibitors,PDL1 (22C3) positivity >50% (90% in tumor cells) offers a treatment option. CONCLUSIONS: Studies demonstrated that anti–PD-1/PD-L1 agents have important anti-tumor activity increasing survival rate in NSCLC patients . CLINICAL IMPLICATIONS: The importance of obtaining a correct diagnosis as early as possible, as well as the detection and genotyping of the activating mutations in the EGFR gene as well as ALK gene and PDL1 DISCLOSURE: Nothing to declare. KEYWORD: pulmonary adenocarcinoma, EGFR, PDL1