PMC5723122_01
Radiographic response followed by progression in a EGFR L858R NSCLC with response to first-line erlotinib and second-line osimertinib.. Notes: Arrows depict treatment timeline events, and red circles denote bony lesions.. Abbreviations: ctDNA, circulating tumor DNA; EGFR, epidermal growth factor receptor; LLL, left lower lobe; NSCLC, non-small-cell lung cancer.
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A 69-year-old Asian female never smoker presented in July 2014 with back and hip pain and was found to have a 4.4-cm left lower lobe mass, a right ischium bone metastasis and malignant adenopathy (Figure 1). She achieved a good partial response and symptomatic improvement lasting 13 months, at which time a new left lower lobe lesion 1.8 x 1.3 cm as well as increased activity in her known bony disease was seen (Figure 1). She had symptomatic improvement and partial response lasting 12 months, at which point a new left pelvic mass with bony involvement was identified (Figure 1). In the absence of available trials, she was transitioned to carboplatin plus pemetrexed and achieved stable disease after three cycles (Figure 1) followed by disease progression.
(A) Integrated genomics viewer highlighting the presence of a C>T at codon 790 (EGFR T790M) mutation (red) oriented in cis with a G>A at codon 796 (EGFR G796S) mutation (green). Overlapping reads spanning the T790M and G796S indicate cis orientation on the same allele. (B) The RTK sequence alignments across relevant TKIs with the gatekeeper residue highlighted in yellow and the relevant solvent-front residue in teal.. Abbreviations: EGFR, epidermal growth factor receptor; RTK, receptor tyrosine kinase; TKI, tyrosine kinase inhibitor.
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Overlapping sequencing reads spanning the T790M and G796S confirmed cis orientation (Figure 2A).