A Rare EGFR R748T Mutation in A Squamous Cell Lung Carcinoma Patient with PD-L1 High Expression and Response to Immuno-Chemo Combination Therapy

Abstract

Background: In present, patients with stage IV or recurrent/metastatic non-small cell lung cancer (NSCLC) whose tumors harbor programmed death ligand 1 (PD-L1) expression and active Epidermal Growth Factor Receptor (EGFR) mutations should receive initial EGFR tyrosine kinase inhibitors (TKIs) based on clinical guidelines and practice. However, high PD-L1 expression correlates with primary resistance to EGFR-TKIs in treatment advanced EGFR-mutant lung cancer patients, the optimal use of ICI therapy in patients with actionable EGFR mutations remains an important field of ongoing research. Some studies also showed that patients with uncommon EGFR mutations have a good immunotherapy potential.Case prestation: Here, we report a 56-year old advanced squamous cell lung carcinoma (SCC) patient with a rare active mutation in EGFR gene (EGFR p.R748T) and PD-L1 expression who responded well to the immune-chemo combination therapy (pembrolizumab with nab-paclitaxel and nedaplatin). Conclusion: The EGFR R748T mutation is an uncommon active mutation and there is no report about immuno-chemo therapy on patient with EGFR R748T mutation and PD-L1 high expression. The result presented in this case provides a feasible therapy for some patients who harbor rare active EGFR mutations (except for G719X, L861Q, S768I, and Ex20 ins) with high PD-L1 expression.