PMC9396254_01
NGS panel results showed EGFR mutation L747P (2239-2240 TT>CC) in exon 19.
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ALK, BRAF, EGFR, ERBB2, KRAS, MET, NTRK, RET, and ROS1), and PD-L1 (Ventana SP263) expression detection in tumor tissue paraffin section (30% neoplastic cell) found EGFR exon 19 L747P mutation (EGFR NM_005228.3 Exon19 c.2239_2240del TTinsCC p.L747P) ( Figure 1 ) with a mutation abundance of 14.21% and PD-L1 expression was greater than 10% in tumor cells (TCs). After the operation, the patient did not receive any antitumor therapy due to personal refusal.
Craniocerebral CT about clinical response to afatinib therapy at different times. (A) Baseline before afatinib treatment. (B) Brain metastases progressive disease (PD) after 4 months.
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Subsequently, the patient started oral afatinib 40 mg daily as first-line therapy on 4 August 2020 ( Figure 2A ), and achieved stable disease for 7 months until January 2021 ( Figure 2B ).
Craniocerebral MRI about clinical response to dacomitinib therapy at different times. (A) Baseline before dacomitinib treatment. (B) Brain metastases partial response (PR) after 2 months. (C) Brain metastases PR after 4 months. (D) Brain metastases PR after 6 months.
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After experiencing dizziness and headache, the patient was reexamined by brain MRI on 19 January 2021, which revealed a new brain metastasis in the left occipital lobe ( Figure 3A ). The patient underwent MRI 2 months later, and found that the lesion was significantly reduced, the efficacy achieved partial response (PR) ( Figure 3B ), and follow-up MRI at 4 and 6 months showed that the lesion continued to shrink and almost disappeared ( Figures 3C, D ).
Craniocerebral MRI about clinical response to dacomitinib therapy at different times. (A) Brain metastases still PR after 12 months. (B) Brain metastases PD after 17 months.
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The patient continued to receive dacomitinib until new right parietal lobe brain metastases were identified on 23 June 2022 (the cutoff day,  Figures 4A, B ), and the progression-free survival (PFS) was 17 months ( Figure 5 ).
Treatment history and genomic results during the patient's clinical course.
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The patient continued to receive dacomitinib until new right parietal lobe brain metastases were identified on 23 June 2022 (the cutoff day,  Figures 4A, B ), and the progression-free survival (PFS) was 17 months ( Figure 5 ).