PMC7645070_01
CT scan showed that the tumor size decreased after icotinib treatment, osimertinib treatment, and radiotherapy and chemotherapy, respectively. After icotinib treatment, the tumor size (yellow arrow) decreased from 39 mm*36 mm to 39 mm*27 mm in February 2016. After icotinib-resistance and osimertinib treatment, the tumor size (yellow arrow) decreased from 42 mm*34 mm to 40 mm*22 mm in November 2017. After radiotherapy and chemotherapy during March 2018 to June 2018, the tumor size decreased from 49 mm*32 mm to 41 mm*20 mm. After October 2018, pleural effusion (green arrows) was developed in the patient and extracted. The patient achieved a stable disease (SD) during crizotinib treatment in June 2019, compared with October 2018, with tumor mass measuring from 36 mm*30 mm to 36 mm*27 mm.
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F1
A 71-year-old male patient without a family history was diagnosed with poorly differentiated lung adenocarcinoma with lymph node metastasis (Figure 1). T790M were 0.91 and 0.35%, respectively) in August 2017 after icotinib-resistance (Figure 2, Table 1). The strategy of targeted drug treatment changed from icotinib to osimertinib in September 2017 and lasted for 14 months. The patient achieved stable disease (SD) and another CT scan with a tumor mass measuring 40 mm*22 mm in November 2017 demonstrated that osimertinib worked well and the tumor mass decreased (Figure 1).
Schematic diagram of the treatment of the patient.
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F2
T790M were 0.91 and 0.35%, respectively) in August 2017 after icotinib-resistance (Figure 2, Table 1). The strategy of targeted drug treatment changed from icotinib to osimertinib in September 2017 and lasted for 14 months. The patient achieved stable disease (SD) and another CT scan with a tumor mass measuring 40 mm*22 mm in November 2017 demonstrated that osimertinib worked well and the tumor mass decreased (Figure 1). TP53 c.994-1G>C, and FGF23 p.L224*, generally showed a similar pattern with MET amplification, which was also consistent with changes of the expression level of carcinoembryonic antigen (CEA) in the patient (Figure 3, Supplementary Information 2). These results implied that the tumor was alleviated shortly after receiving crizotinib and relapsed later, which is consistent with increased tumor mass measuring 48 mm*30 mm by CT scan in October 2019.
The correlation between dynamic variant allele fractions/copy numbers of mutated genes and the level of carcinoembryonic antigen (CEA) of the patient over 2 years. The left Y axis represents the CEA level. The right Y axis represents the variant allele fractions of EGFR 19del (upper panel) or the copy number of MET amplification (lower panel). The X axis represents the date of detections.
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F3
TP53 c.994-1G>C, and FGF23 p.L224*, generally showed a similar pattern with MET amplification, which was also consistent with changes of the expression level of carcinoembryonic antigen (CEA) in the patient (Figure 3, Supplementary Information 2). These results implied that the tumor was alleviated shortly after receiving crizotinib and relapsed later, which is consistent with increased tumor mass measuring 48 mm*30 mm by CT scan in October 2019.