Complete Response to Immunotherapy Plus Chemotherapy After an Unusual Clinical Response to Afatinib and Stereotactic Radiosurgery in a Patient With Metastatic EGFR-Mutant Non–Small-Cell Lung Cancer
| Autor: | Jorge Madrid, Héctor Galindo, César Sánchez, Erica Koch, Mauricio P. Pinto, Eugenio Vinés, Sebastian Mondaca, José Peña, Benjamin Walbaum, Bruno Nervi, M. Loreto Bravo, Jose R. Valbuena, Francisco Acevedo, Marcelo Garrido, Gonzalo Pizarro, Matías Muñoz-Medel, Roger Gejman, Sergio González, Juan Briones, Carolina Ibañez, Miguel Cordova-Delgado |
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| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Pulmonary and Respiratory Medicine Oncology Cancer Research medicine.medical_specialty business.industry medicine.medical_treatment Standard treatment Afatinib Immunotherapy Pembrolizumab medicine.disease Radiation therapy 03 medical and health sciences T790M 030104 developmental biology 0302 clinical medicine Epidermal growth factor 030220 oncology & carcinogenesis Internal medicine medicine Lung cancer business medicine.drug |
| Zdroj: | Clinical Lung Cancer. 21:e250-e254 |
| ISSN: | 1525-7304 |
| DOI: | 10.1016/j.cllc.2020.01.012 |
| Popis: | Background Checkpoint inhibitors (CPIs) such as Pembrolizumab have recently become the standard treatment for Non-Small Cell Lung Cancers (NSCLC) in patients without Epidermal Growth Factor (EGFR) gene alterations. Previous reports suggest no significant benefit from CPI treatments among EGFR mutant NSCLC patients and recommend the use of Tyrosine Kinase Inhibitors such as Afatinib. Case presentation: Herein, we report a rare case of a 39-year old, light-smoker woman with a metastatic EGFR mutant NSCLC (exon-19 deletion) that exhibited rapid progression and an unusual clinical response to Afatinib without changes in tumor histology. Tumor was negative for PDL1. Biopsy analyses by NGS prior and after Afatinib treatment indicated an increase in focal somatic copy number alterations (fSCNAs) but no T790M or c-MET amplification, and a low Tumor Mutational Burden (TMB). Given her rapid progression and deterioration, and despite its PDL1- status and her low TMB patient started treatment with Pembrolizumab plus chemotherapy. Surprisingly, patient displayed a complete response after just 4 cycles and is soon to complete a year in remission. Conclusions We speculate intratumoral heterogeneity, the combination of radiotherapy plus immunotherapy or the concomitant use of chemotherapy plus immunotherapy could explain the observed response in this patient. Also, based in our data we suggest the SBRT/CPI combination could be an option for Tyrosine Kinase Inhibitor-refractory EGFR mutant NSCLC patients or as a second-line treatment. |
| Databáze: | OpenAIRE |
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