Osimertinib-induced BRAF mutation in a single metastatic lesion among multiple pulmonary lesions in a case of lung cancer with EGFR exon 19 deletion.

IF 0.8 Q4 RESPIRATORY SYSTEM Respirology Case Reports Pub Date : 2024-08-13 eCollection Date: 2024-08-01 DOI:10.1002/rcr2.70003
Hiroyuki Miura, Jun Miura, Shinichi Goto, Tomoko Yamamoto
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Abstract

One of the resistant mechanisms of EGFR-TKIs is BRAF V600E mutation. Herein, we present the case of a 54-year-old Japanese female who underwent a right middle lobectomy for pathological stage IIB lung adenocarcinoma. One year and nine months after the surgery, she developed multiple intrapulmonary metastases. Osimertinib was administered due to EGFR exon 19 deletion. Although all intrapulmonary metastases had shrunk, the nodule at the superior segment of left lung enlarged after postoperative 4 years. The tumour was resected and BRAF V600E mutation and exon 19 deletion were detected. Three months after treatment with dabrafenib and trametinib instead of osimertinib, the remaining intrapulmonary metastases increased again. The continued growth of the metastatic foci even after EGFR-TKI may indicate an acquired resistance. Thus, a repeat biopsy will aid in confirming the new gene expression. It should have been necessary to administer an additional dose of dabrafenib and trametinib without discontinuing osimertinib.

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一例表皮生长因子受体19外显子缺失肺癌患者的多个肺部病灶中,单个转移病灶出现奥希替尼诱导的BRAF突变。
EGFR-TKIs 的耐药机制之一是 BRAF V600E 突变。本文介绍了一例 54 岁的日本女性病例,她因病理分期为 IIB 期的肺腺癌接受了右中叶切除术。术后一年零九个月,她出现了多发性肺内转移。由于表皮生长因子受体外显子19缺失,她接受了奥希替尼治疗。虽然所有肺内转移灶都已缩小,但术后 4 年,左肺上段的结节增大。肿瘤被切除,并检测到 BRAF V600E 突变和 19 号外显子缺失。用达拉菲尼和曲美替尼代替奥希替尼治疗三个月后,剩余的肺内转移灶再次增大。即使使用了表皮生长因子受体抑制剂(EGFR-TKI),转移灶仍在继续生长,这可能表明患者存在获得性耐药。因此,重复活检将有助于确认新的基因表达。应该有必要在不停用奥希替尼的情况下追加达拉菲尼和曲美替尼的剂量。
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来源期刊
Respirology Case Reports
Respirology Case Reports RESPIRATORY SYSTEM-
CiteScore
1.40
自引率
0.00%
发文量
178
审稿时长
8 weeks
期刊介绍: Respirology Case Reports is an open-access online journal dedicated to the publication of original clinical case reports, case series, clinical images and clinical videos in all fields of respiratory medicine. The Journal encourages the international exchange between clinicians and researchers of experiences in diagnosing and treating uncommon diseases or diseases with unusual presentations. All manuscripts are peer-reviewed through a streamlined process that aims at providing a rapid turnaround time from submission to publication.
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