PMC8214534_01
Imaging scans show: (A) a mass in the left upper lung lobe; (B) left supraclavicular lymph node metastasis; (C) left rib metastasis before afatinib therapy; (D) partial response after 2 months of afatinib treatment; (E) disease progression in brain; (F) obstructive pneumonia developed.
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A 50-year-old male former smoker underwent left upper lobectomy in January 2018 after an irregular nodule was found in the left upper lobe during a screening computed tomography (CT) of the thorax (Figure 1A). The diagnosis of stage I A3 (pT1cN0M0) lung adenocarcinoma (ADC) and intraductal tumor thrombus was confirmed by pathological examination, and the patient received adjuvant chemotherapy with pemetrexed 500 mg/m2 and cisplatin 75 mg/m2 every 21 days for 4 cycles from January 2018 to April 2018. The patient was treated with chemotherapy again (pemetrexed and cisplatin) starting in February 2019 due to recurrence of the cancer in the left supraclavicular lymph node (LN) and left rib at 13 months after surgery (Figure 1B and C). The patient was considered to have disease progression after 2 cycles of chemotherapy. ADC. After 2 months of afatinib treatment, CT examinations showed that partial response was achieved (Figure 1D). He remained on afatinib for 11 months, after which he experienced only intracranial disease progression (Figure 1E). Obstructive pneumonia developed with signs of disease progression after four months of osimertinib (Figure 1F). The timeline of the clinical course is summarized in Figure S1.
Multibiomarker immunohistochemistry confirms pathological typing. (A) Pathologic examination revealed adenocarcinoma of the primary tumor. (B) The pathological result of recurrent pulmonary lesions by repeat biopsy was squamous cell carcinoma. (400xmagnification).
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TG and P53 (Figure 2A). ALK, TTF-1 and Napsin A (Figure 2B). After occurrence of obstructive pneumonia, his condition deteriorated resulting in antitumor treatment discontinuation, and subsequently treatment changed to best supportive care.
Next-generation sequencing analysis of KIF5B-EGFR fusion mutations in the patient's postoperative tumor tissue. (A) Integrative Genomics Viewer snapshot of KIF5B-EGFR fusion; (B) a schematic map of the KIF5B-EGFR fusion protein domain structure.
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The tumor tissue was also subjected to NGS (Berry oncology, Fujian China) and showed a novel KIF5B-EGFR fusion (Figure 3A and B).