Efficacy of Osimertinib in Lung Squamous Cell Carcinoma Patients with EGFR Gene Mutation–Case Report and a Literature Review

Abstract

Non-small cell lung cancer (NSCLC) is the most common type of lung cancer and the leading cause of cancer-related mortality worldwide. It is responsible for 80–85% of lung cancer cases. NSCLC can be divided into several groups, led by adenocarcinoma (ADC)–40–50% and squamous cell carcinoma (SCC)–20–30%. The development of new molecular therapies targeting particular abnormalities such as mutations in the EGFR (Epidermal Growth Factor Receptor) gene or ROS1 or ALK genes rearrangements resolved in novel strategies in advanced NSCLC management. EGFR mutation occurs mostly in patients with ADC and those patients are mostly females with no or light smoking history. The hereby presented patient fitted the ADC characteristics, while they were diagnosed with SCC. The unusual diagnosis implied further genetic testing, which established the occurrence of L858R substitution in exon 21 in the EGFR gene. A 63-year-old female was admitted to the unit due to a dry cough, pain in the right chest area and dyspnoea. When diagnosed, the patient had a peripheral mass in the right lung superior lobe (55 × 40 mm), satellite nodules in the apex of the same lung and packets of disintegrating lymph nodes. Positron Emission Tomography (PET-CT) confirmed a diffuse neoplastic process qualified as stage IV on the TNM scale. Due to EGFR gene mutation, the woman was administered osimertinib, however, the treatment did not succeed, and other therapeutic solutions were undertaken. The patient died 10 months after diagnosis. Patients with advanced ADC harboring EGFR mutation can receive osimertinib, a third-generation tyrosine kinase inhibitor (TKI), however, the use of TKIs in SCC remains controversial. In some published cases, osimertinib treatment led to success, in others, the therapy did not result in the expected final effect. Small sample groups and diverse molecular backgrounds indicate the need for further research in this field. Thus, the treatment decision-making process in those patients overall remains extremely demanding and ambiguous.

Repurposing EGFR Inhibitors for Oral Cancer Pain and Opioid Tolerance

“…EGFR inhibitors for cancer therapies are an area of active research, with many already on the market [121][122][123][124][125][126][127][128][129][130][131][132][133]. Emerging evidence suggests that EGFR expressed along the pain signaling pathway may play a significant role in regulating pain and promoting opioid analgesic tolerance and dependence.…”

Efficacy of osimertinib for lung squamous cell carcinoma with de novo EGFR T790M‐positive: Case report and literature review

“…To the best of our knowledge, a literature search for case reports of osimertinib in SCC patients with EGFR mutation‐positive tumors, yielded 16 cases, including the present case 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 (Table 1 ). The treatment outcome breakdown was 12 cases of PR and four cases of PD, and many were reported to be effective, but the duration of response was limited in some cases.…”