PMC8093742_01
The timeline of the patient's treatment history and the response of the tumor lesions. (A) the timeline of treatments; (B) the chest CT image at initial diagnosis; (C) disease progression (PD) on osimertinib; (D) partial response (PR) to osimertinib+ gefitinib; (E) PD on osimertinib+ gefitinib; (F) PR to the treatment of osimertinib+ anlotinib+ chemotherapy; (G) PD on osimertinib+ anlotinib+ chemotherapy.
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The patient's diagnostic and treatment history was summarized in Figure 1A. Chest computed tomography (CT) scan revealed consolidation in right lower lung accompanied with right pleural effusion and scattered miliary opacities on both lungs (Figure 1B). In Dec 2018, the patient developed disease progression (PD) with an enlarged lesion on the right lung, increased volume of pleural effusion, and atelectasis of the right lobe, revealed by chest CT scan (Figure 1C). In Jan 2019, the patients started third-line treatment of osimertinib (80mg/QD) combined with gefitinib (250 mg/QD) and achieved a PR one month later with shrinkage of right lung lesion and reduction of pleural effusion (Figure 1D). CT scan showed truncated bronchus in the right lower lobe, increased right pleural effusion, multiple nodules on the right lung and aggravated lung infection (Figure 1E). A repeated CT scan was performed in Dec 2019 and confirmed that the patient remained on PR (Figure 1F). She subsequently received osimertinib and anlotinib maintenance treatment until May 2020, when the disease progressed (Figure 1G), resulting in a PFS of 9 months.
Allelic context and frequencies of EGFR C797S mutation and EGFR T790M mutation during treatments. (A) An in trans configuration at osimertinib PD (progressive disease); (B) an in-cis configuration at osimertinib+ gefitinib PD; (C) both in trans and cis configurations at osimertinib+anlotinib PD.
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T790M-trans-C797S in both samples (Figure 2A). The AF of plasma 19 del and T790M increased to 0.24% and 0.20%, respectively. T790M (AF: 0.57%) (Figure 2B). The patient was subsequently treated with a combined regimen of osimertinib (80mg/QD), anlotinib (12mg/QD), pemetrexed (800mg), and cisplatin (30mg 1-3day). T790M (AF: 0.49%) (Figure 2C).