Epidermal growth factor receptor (EGFR) mutations are common driver genes in nonsmall-cell lung cancer and have different sensitivities to EGFR-tyrosine kinase inhibitors (EGFR-TKIs). EGFR is divided into classic mutations and rare mutations. Classic mutations are well known, but the understanding of rare mutations is not sufficient. In this article, we summarize the clinical research and treatment progress of rare mutations for different EGFR-TKIs and provide a basis for clinical treatment decisions.
Background
Epidermal growth factor receptor-tyrosine kinase inhibitors (
EGFR
-TKIs) play a dominant role in the treatment of non-small cell lung cancer (NSCLC); however, to date, targeted treatment options have not been identified for patients with
EGFR
exon 20 insertion (ex20ins) mutations. Almonertinib, as the third generation
EGFR
-TKI, can irreversibly bind to
EGFR
ATP binding region and has a favorable therapeutic effect in
EGFR
+
multiple targets inhibition. Almonertinib is suitable for the treatment of NSCLC patients with disease progression and T790M drug resistance mutation positive after other
EGFR
-TKI treatment.
Case Description
We report the case of a female patient with NSCLC with an
EGFR
ex20ins mutation (p.Ala767_Val769dup) identified by next-generation sequencing (NGS). The patient received systemic chemotherapy after surgical resection of the lesion. After the progression of first-line chemotherapy, the patient received sequential targeted therapy with afatinib and poziotinib, achieving progression-free survival (PFS) of 3.2 and 10.4 months, respectively. After the progression, we chose almonertinib when the patient refused to re-chemotherapy. Under the treatment of almonertinib, the PFS time of the patient reached 14 months.
Conclusions
Almonertinib had the most substantial effect, and its use has not been previously reported for NSCLC patients with
EGFR
ex20ins mutations. The successful application of almonertinib reported here indicates that is a potential new treatment regimen for patients with
EGFR
ex20ins mutations.
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