PMC6134962_01
(A-I) Chest CT scans at various time points.. Abbreviations: PR, partial response; PD, progressive disease.
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IV, Figures 1A and 2) in the right lung accompanied by mediastinal lymph node and pleural metastases in the right lung. In April 2011, the patient received targeted gefitinib treatment (250 mg daily [qd] by mouth [po]), and her condition was partially improved after 1 month (May 2011, Figure 1B). However, the pulmonary lesion increased after 20 months of continuous treatment (January 2013, Figure 1C). The patient then received discontinued chemotherapy with pemetrexed and carboplatin, but the pulmonary lesion continually increased, with the tumor eventually occupying almost the entire right lung (January 2016, Figure 1D). After 1 month of treatment, the size of the pulmonary lesion was dramatically reduced (February 2016, Figure 1E). However, 1 year later, a CT scan showed that the pulmonary lesion had again increased and that the disease had progressed (February 2017, Figure 1F). After 6 weeks (2 cycles), the pulmonary lesion was smaller, and the symptoms of chest tightness and shortness of breath were significantly relieved (March 2017, Figure 1G). However, after 3 months of treatment (4 cycles), the pulmonary tumor had enlarged again, with disease progression (May 2017, Figure 1H). Partial remission was observed after 1 month of treatment (June 2017, Figure 1I).
Representative histopathological image of the tumor (H&E staining, 10x).
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IV, Figures 1A and 2) in the right lung accompanied by mediastinal lymph node and pleural metastases in the right lung. In April 2011, the patient received targeted gefitinib treatment (250 mg daily [qd] by mouth [po]), and her condition was partially improved after 1 month (May 2011, Figure 1B).
EGFR mutation analysis of the patient's plasma before (A) and after (B) brigatinib treatment.. Note: The mutation abundance was calculated by a commercial service Pulmocan  provided by Geneseeq (Nanjing, People's Republic of China).
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We thus detected circulating tumor DNA (ctDNA) in plasma, and the results showed an L858R mutation in EGFR exon 21 (abundance 6.0%), a T790M mutation in exon 20 (abundance 1.7%), and a cis-C797S mutation in exon 20 (abundance 0.6%) (Figure 3A). T790M mutation in exon 20 (abundance 1.6%), and C797S mutation in exon 20 (abundance 0.2%) (Figure 3B).