A 69-year-old man visited our pulmonary medicine department for dyspnea. Chest computed tomography (CT) revealed ground-glass opacity bilaterally in the lungs. Upon performing a transbronchial lung biopsy (TBLB), organizing pneumonia was diagnosed. His electrocardiogram revealed low voltage, and the cardiac ultrasound revealed hypertrophy of the interventricular septum. The patient had bilateral carpal tunnel syndrome, and amyloidosis was suspected. Congo red stain was added to the lung biopsy specimen. Amyloid deposition of transthyretin (ATTR) was positive, mutations with amino acid changes were not observed in the TTR gene. Wild-type ATTR Amyloidosis (ATTRwt amyloidosis) was diagnosed using a TBLB. Chest CT after treatment with steroids revealed diffuse alveolar-septal amyloidosis.

Background Patients with epidermal growth factor receptor (EGFR)‐mutated, advanced non–small cell lung cancer have received immunochemotherapy as one of the treatment options after tyrosine kinase inhibitor (TKI) failure. Methods We retrospectively examined EGFR‐mutant patients treated with atezolizumab‐bevacizumab‐carboplatin‐paclitaxel (ABCP) therapy or platinum‐based chemotherapy (Chemo) after EGFR‐TKI therapy at five institutions in Japan. Results A total of 57 patients with EGFR mutation were analyzed. The median progression‐free survival (PFS) and overall survival (OS) in the ABCP (n = 20) and Chemo (n = 37) were 5.6 and 20.9 months, 5.4 and 22.1 months, respectively (PFS, p = 0.39; OS, p = 0.61). In programmed death‐ligand 1 (PD‐L1)–positive patients, median PFS in the ABCP group was longer than in the Chemo group (6.9 vs. 4.7 months, p = 0.89). In PD‐L1–negative patients, median PFS in the ABCP group was significantly shorter than in the Chemo group (4.6 vs. 8.7 months, p = 0.04). There was no difference in median PFS between the ABCP and Chemo groups in the subgroups of brain metastases, EGFR mutation status, or chemotherapy regimens, respectively. Conclusion The effect of ABCP therapy and chemotherapy was comparable in EGFR‐mutant patients in a real‐world setting. The indication for immunochemotherapy should be carefully considered, especially in PD‐L1–negative patients.

BackgroundPatients with epidermal growth factor receptor (EGFR)-mutated, advanced non-small cell lung cancer have received immunochemotherapy as one of the treatment options after tyrosine kinase inhibitor (TKI) failure. We examined the efficacy of immunochemotherapy in actual clinical practice and investigated subgroups of EGFR-mutant patients suitable for immunochemotherapy.MethodsWe conducted a multicenter retrospective cohort study of EGFR-mutant patients treated with atezolizumab-bevacizumab-carboplatin-paclitaxel (ABCP) therapy versus platinum-based chemotherapy (Chemo) and immune checkpoint inhibitor (ICI) monotherapy after EGFR-TKI therapy. Progression-free survival (PFS), according to underlying factors, including programmed death-ligand 1 (PD-L1) status, was also analyzed between the ABCP and Chemo groups.ResultsOf the 65 patients, 20, 37, and 8 received ABCP therapy, chemotherapy, and ICI monotherapy, respectively. The median PFS and overall survival periods in the ABCP, Chemo and ICI groups were 5.6 and 20.9 months, 5.4 and 22.1 months, and 1.2 and 9.2 months, respectively (PFS, P = 0.63; OS, P = 0.11). The median PFS periods of PD-L1-positive patients in the ABCP and Chemo groups were 6.9 and 4.7 months, respectively (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.41–2.17, P = 0.89). The median PFS of PD-L1-negative patients in the Chemo group (8.7 months) was significantly longer than that in the ABCP group (4.6 months) (HR, 0.34; 95% CI, 0.12–0.97, P = 0.04).ConclusionsThe effect of ABCP therapy was similar to chemotherapy in EGFR-mutant patients in a real-world setting. Particularly, for PD-L1-negative patients, platinum-based chemotherapy may be recommended over ABCP therapy.

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