PMC9170288_01
The clinical course according to check CT scan findings. (A, F) Baseline CT scan at diagnosis in April 2020. (B, G) SD on osimertinib in July 2020. (C, H) SD on osimertinib in October 2020. (D, I) PR on aumolertinib in March 2021. (E, J) SD on aumolertinib in July 2021. PR, partial response. SD, stable disease.
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The follow-up of the first 3 months showed a stable tumor in the lung nidus (3.9 x 2.6cm) (Figures 1B, G). Later, tumor analysis revealed that the size of the tumor was partially decreased (2.9 x 1.6 cm) (Figures 1D, I). Interestingly, regular follow-up showed gradual recovery in the symptoms (Figures 1E, J); tumor size reached stable disease (SD), the ejection fraction improved to 66% (Figure 4A), the pro-BNP decreased to 137 ng/L (Figure 4B), and the left ventricle function become normal, which showed significant improvement in the cardiac function as well as the NSCLC condition.
The next-generation sequencing analysis revealed that L858R mutation in exon 21 of the EGFR gene was visualized by IGV software.
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Moreover, the next-generation sequencing analysis discovered L858R mutation in exon 21 of the EGFR gene (Figure 2).
The medicine administration with indicated time periods shown as a flowchart diagram.
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The entire treatment timeline of anti-tumor therapy is shown in a flowchart diagram (Figure 3).
The detection of cardiac function in different time periods. (A) Ejection fraction in different time periods. (B) Brain natriuretic peptide precursor (pro-BNP) in different time periods.
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H). However, an MRI of the heart exposed pleural and pericardial effusions, and the echocardiogram (ECG) further indicated an obvious severe hypokinesis, with a left ventricular ejection fraction (LVEF) of 36% and the left ventricle was dysfunctioning (Figure 4A; Tables 2 and 3). In addition, the level of NT pro-BNP was gravely increased (6,830  ng/L) (Figure 4B). Four weeks after the new treatment regimen, the LVEF improved to 52% (Figure 4A) including better cardiac function (Table 3); however, NT pro-BNP was further welled to 8,000 ng/L (Figure 4B). Fortunately, the cardiac function returned to normal (Table 3), as indicated by LVEF (57%) (Figure 4A) and the reduced level of NT pro-BNP (901 ng/L) (Figure 4B). Interestingly, regular follow-up showed gradual recovery in the symptoms (Figures 1E, J); tumor size reached stable disease (SD), the ejection fraction improved to 66% (Figure 4A), the pro-BNP decreased to 137 ng/L (Figure 4B), and the left ventricle function become normal, which showed significant improvement in the cardiac function as well as the NSCLC condition.
The changes in RV5 of electrocardiogram at cardiac failure and during recovery treatment.
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The changes in electrocardiogram at cardiac failure and during recovery treatment were also monitored (Figure 5), which showed that RV5 was more than 2.5 mV when the patient suffered a cardiac failure, and the high voltage suggested left ventricular hypertrophy.