Long-term survival of a non-small cell lung cancer patient with EGFR-mutated brain metastases: a case report

Abstract

Background: Lung cancer is the leading cause of cancer-related death worldwide. Up to 85% of lung cancer is non-small cell lung cancer (NSCLC) and most patients present with advanced disease at first diagnosis. Targeted therapy plays an important role in the treatment of advanced NSCLC. Epidermal growth factor receptor (EGFR) mutation is a predictive marker of sensitivity to EGFR tyrosine kinase inhibitors (TKIs). Patients with EGFR-mutated NSCLC are prone to developing central nervous system (CNS) metastasis and poor prognosis (4-6 months). Brain metastases (BMs) remain a tricky problem in NSCLC patients and impose a distinct challenge for clinicians.Case Description: This article details a patient with EGFR-mutated BMs accepting a series of treatments but without chemotherapy, resulting in significantly prolonged survival with overall survival (OS) over 8 years and improved clinical symptoms. The patient in our case received four lines of treatments and the progression-free survival (PFS) in each line were longer than the previously reported without exception. It is worth noting that the combination of osimertinib and bevacizumab used in the fourth-line therapy has a PFS of 31 months and has not progressed so far. Conclusions:Our case demonstrates that it is possible to achieve long-term survival in advanced EGFRmutated NSCLC with multiple BMs and systemic progression through a reasonable therapeutic schedule.

Long‐term survival of a patient with epidermal growth factor receptor (EGFR)‐mutant non‐small cell lung cancer (NSCLC) and untreated multiple brain metastases treated with zorifertinib: A case report

“…Different from other case reports of long OS in EGFR ‐mutant NSCLC patients with initially asymptomatic, solitary BM or initially no BM after four‐line therapies including combination with radiotherapy, or off‐label use of osimertinib (double dose), 19 , 20 the patient in this report had more poor prognostic factors, including EGFR L858R and initially diagnosed symptomatic multiple BM. She also received only sequential treatment of zorifertinib and a third‐generation EGFR‐TKI without intracranial radiotherapy.…”

“…10,18 In previous studies, first-line zorifertinib was particularly effective in controlling BM (extracranial PD is the main pattern of PD), and the main acquired resistance mutation was EGFR T790M which is subsequently treatable with third-generation EGFR-TKIs, helping to prolong OS of patients; the median OS was 34.1 months in patients subsequently treated with osimertinib in CTONG1702, and is consistent with that of the phase 3 EVEREST study (data on file). 12,13 Different from other case reports of long OS in EGFRmutant NSCLC patients with initially asymptomatic, solitary BM or initially no BM after four-line therapies including combination with radiotherapy, or off-label use of osimertinib (double dose), 19,20 the patient in this report had more poor prognostic factors, including EGFR L858R and initially diagnosed symptomatic multiple BM. She also received only sequential treatment of zorifertinib and a third-generation EGFR-TKI without intracranial radiotherapy.…”