[Resistance to anti-EGFR through the successive and cumulative acquisition of two new oncogenic addictions: BRAF and ALK].

Autor:	Messekher M; Service de pneumologie, pôle cœur-poumons hôpital Arnaud-de-Villeneuve, CHU de Montpellier, 371, avenue du Doyen-Gaston-Giraud, 34295 Montpellier cedex 5, France. Electronic address: merouane.messekher@chu-montpellier.fr., François H; Service de pneumologie, centre hospitalier du Taaone, Tahiti, Polynésie française., Denis MG; Laboratoire de biochimie, CHU de Nantes, Nantes, France., Ferrer-Lopez P; Clinique Mamao, Tahiti, Polynésie française., Bost-Bezeaud F; Service d'anatomie pathologique, centre hospitalier du Taaone, Tahiti, Polynésie française., Mazières J; Service de pneumologie, hôpital Larrey, CHU de Toulouse, Toulouse, France., Parrat E; Service de pneumologie, centre hospitalier du Taaone, Tahiti, Polynésie française.
Jazyk:	francouzština
Zdroj:	Revue des maladies respiratoires [Rev Mal Respir] 2024 Jun; Vol. 41 (6), pp. 451-454. Date of Electronic Publication: 2024 May 24.
DOI:	10.1016/j.rmr.2024.05.003
Abstrakt:	Targeted therapies are the standard first-line treatment for metastatic lung adenocarcinoma with certain molecular abnormalities. These abnormalities are particularly common in Southeast Asia and French Polynesia. A 51-year-old Tahitian female non-smoker was diagnosed in 2018 with stage IV lung adenocarcinoma harboring a p.L858R EGFR mutation. She received gefitinib as first-line treatment. Due to locoregional progression and the presence of a resistance mutation (p.T790M of EFGR), she received osimertinib as second-line treatment, after which chemotherapy was proposed as 3rd-line treatment. An additional biopsy detected not only the previously known EGFR mutation, but also a BRAF p.V600E mutation. Following disease progression during chemotherapy, the patient received targeted therapies combining dabrafenib, trametinib and osimertinib. Due to a dissociated response after four months of treatment, a 5th line of paclitaxel bevacizumab was initiated. Subsequent to additional progression and given the ALK rearrangement shown on the re-biopsy, 6th-line treatment with alectinib was proposed. As the response was once again dissociated, a final line was proposed before stopping active treatments due to their toxicity and overall deterioration in the patient's state of health. This exceptional case is characterized by resistance to anti-EGFR through the successive and cumulative acquisition of two new oncogene addictions. The authors underline the importance of re-biopsy at each progression, leading (if at all feasible) to yet around round of targeted therapy. (Copyright © 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.)
Databáze:	MEDLINE
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