PMC8721274_01
Pathological diagnosis and molecular diagnosis. (A,B), tumor specimen was applied to apex of right lung with a pathological diagnosis of lung adenocarcinoma (hematoxylin-eosin staining: 100x and 200x). (C), Three-dimensional structure of EGFR protein with L718Q mutation predicted by MODELLER. Yellow represent structure of EGFR T790M, blue represent EGFR L718Q mutation, green represent TKI, and red circle present site of L718Q mutation. (D-F), the mutations of EGFR were analyzed through NGS in a laboratory accredited by the College of American Pathologists (CAP) and Clinical Laboratory Improvement Amendment (CLIA) (3D Medicines Inc., Shanghai, China).
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F1
She underwent thoracoscopic right middle and lower lobectomy, partial left atrial resection, pericardiotomy, and lymph node dissection on November 21, 2017, with a confirmed histopathological diagnosis of stage IIIC adenocarcinoma of the right middle lobe (pT4N3M0) ( Figures 1A,B ). The patient was found to carry an EGFR exon 19 deletion mutation by analysis of tissue specimens using next-generation sequencing (NGS) (Figure 1C). A CT scan at that time showed progressive disease (PD), and analysis of circulating tumor DNA (ctDNA) revealed the EGFR T790M mutation (Figure 2B, 1D).
Acquired resistance to osimertinib and response to almonertinib. (A), the various treatments the patient received and the duration of the various treatments. (B), images of the patient's metastatic lung, liver and brain disease.
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F2
She received icotinib (125 mg/d, tid) treatment (Figure 2A). A CT scan at that time showed progressive disease (PD), and analysis of circulating tumor DNA (ctDNA) revealed the EGFR T790M mutation (Figure 2B, 1D). CT showed metastases in the bilateral parietal and left cerebellar regions and enlargement of the metastases in the liver ( Figure 2B ). Figure 2B ). Four months after almonertinib therapy, she was discharged from the hospital, though almonertinib was discontinued because of serious electrolyte disorders and heart failure.