BackgroundSmall cell lung cancer (SCLC) transformation is one of the resistance mechanisms associated with epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs). Rechallenge with the first-line TKI after the second-line chemotherapy is suggested as a salvage treatment despite modest efficacy.Case presentationHere, we report the case of a 72-year-old, never-smoker female diagnosed with multiple metastatic lung adenocarcinoma (cT2aN2M1) harboring EGFR mutations in exon 21 (L858R) of the primary lesion. Despite subsequent treatment with gefitinib for more than a year, the patient developed resistance to the drug. Histological analysis based on rebiopsy at subphrenic mass revealed small cell transformation. After a partial response to irinotecan and carboplatin, the metastatic subphrenic and liver masses presented dramatic progression despite another round of cytotoxic chemotherapy. Rechallenge with erlotinib based on the original EGFR mutation (L858R) without small cell transformation confirmed by re-biopsy of hepatic mass lesions elicited only mixed response. Therefore, cytotoxic chemotherapy comprising irinotecan and carboplatin combined with erlotinib was effective against all the metastatic lesions.ConclusionTo the best of our knowledge, this is the first case of concurrent retreatments with TKIs and chemotherapy previously effective in SCLC transformation.

Background: Breast cancer is a treatable disease, but some women reject conventional treatment in favor of unproven "alternative therapies," which may have serious implications for their survival. Therefore, a process is needed to lead them to more appropriate treatment choices. Case presentation: Here, we present the case of a 51-year-old Korean female diagnosed with early-stage breast cancer (stage IIB, T2N1M0) in Nov. 2015. She refused a standard surgical resection together with chemotherapy and opted instead for moxibustion by nonmedical personnel. Consequently, her preference for alternative therapy without conventional treatment exacerbated her disease. Just a little over a year later, integrative cancer treatment, including chemotherapy based on histological founding, and complementary treatment, comprised of acupuncture, moxibustion, and herbal medicine, were administered for 5 months. Finally, she successfully underwent modified radical mastectomy showing a pathological complete response. She received only adjuvant chemotherapy without any alternative medicine afterwards, and she maintained a good status without recurrence. Conclusion: In the case of breast cancer patients who are resistant to surgery and chemotherapy, integrative therapy considering adverse effects from conventional treatment should be preferred to bitter opposition to alternative medicine.

Objectives: Traditional Korean medicine (TKM) has been supplied as part of a national health care system in South Korea under a dual medical system, however it has been difficult to mix western medicine and TKM medical practices in existing hospitals. For the objective of innovative integration between them, Comprehensive and Integrative Medicine Hospital were founded in Daegu, South Korea. Here, we discussed the clinical outcomes of cancer patients who received integrative cancer treatment (ICT).Methods: A total of 678 patients previously diagnosed with cancer were retrospectively checked in our institution for 2 years. After applying inclusion/exclusion criteria, 573 patients were eligible for the final analysis. The overall survival (OS) of these patients in the aftercare period were determined. We looked at how clinical factors and treatments including chemotherapy, complementary and alternative medicine (CAM), and TKM affected the OS.Results: At the first visit, 212 subjects had no evidence of disease after tumor resection and 355 ones with advanced cancer, who receiving ICT including chemotherapy, CAM, and TKM showed better OS compared to the CAM including TKM or the best supportive care (median OS = 216, 78, and 46 days, respectively). The median OS was not reached in TKM only, even though the sample size was small (N = 12). Even after adjusting for clinical factors associated to liver, renal, and hematologic manifestation, ICT still remained significant.Conclusions: We demonstrated that ICT might be beneficial for advanced cancer regardless of the performance status, liver and renal function, since it positively affected the OS.