PMC8544759_01
Chest X-ray and CT image before treatment (a), after administration of first-line treatment afatinib on Day 12 (b), and after administration of second-line treatment of dabrafenib and trametinib on Day 13 (c).
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Chest computed tomography (CT) showed an obstruction at the right main bronchus and atelectasis at the lower right lobe (Figure 1(a)). First-line treatment with afatinib 40 mg/day was introduced but discontinued due to slight regrowth of the primary tumor confirmed by CT on Day 12 (Figure 1(b)). The drugs were temporally suspended for several days due to Grade-2 fever and loss of appetite, but her symptoms gradually improved, and CT on Day 13 showed a patent airway at the right middle trunk (Figure 1(c)).
Bronchoscopic view of pretreatment tracheal bifurcation (a) and tumor-occluded right middle trunk (b). After administration of dabrafenib and trametinib on Day 23, endoscopic observation showed remarkable endobronchial treatment effect (c, d).
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Bronchoscopy revealed the right middle trunk was completely occluded by the tumor, which showed a white necrotic surface, and the surrounding bronchial epithelium was reddish, displaying cancerous lymphangiopathy (Figure 2(a) and (b)). Endoscopic observation on Day 22 confirmed a remarkable endobronchial treatment effect (Figure 2(c) and (d)).
High sensitivity NGS panel system revealed the primary lung tissue consisted of 16.6% BRAF V600E and 11.1% EGFR exon21 L858R (a), while the bone specimen consisted of 13.5% BRAF V600E and 4.4% EGFR exon21 L858R for gene allele frequency (b).
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Tumor progression was also seen at Th12 of the spinal canal (Figure 3(b)). High sensitivity next-generation sequencing (NGS) panel system revealed the primary lung tissue consisted of 16.6% BRAF V600E and 11.1% EGFR exon21 L858R (Figure 3(a)), while the bone specimen consisted of 13.5% BRAF V600E and 4.4% EGFR exon21 L858R for gene allele frequency (Figure 3(b)).