Gefitinib
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Acquired drug resistance in EGFR-mutated bone metastasised lung adenocarcinoma: case report A 60-year-old man developed acquired resistance during treatment with gefitinib for epidermal growth factor receptor (EGFR)-mutated bone metastasised lung adenocarcinoma. The man, who was diagnosed with EGFR-mutated bone metastasised lung adenocarcinoma, started receiving first-line treatment with gefitinib 250 mg/day [route not stated]. A deep partial remission was achieved. Six months after gefitinib initiation, he experienced a disease progression. Biopsy of the pri-mary tumour showed emergence of EGFR T790M resistance mutation (allele frequency 92%), HER2 S310Y mutation (allele frequency 32%) and HER2 amplification (HER2/CEP ratio 3.49). The emergence of resistance was considered due to T790M and HER2 alterations. Gefitinib was switched to second-line treatment with osimertinib and off-label trastuzumab at a loading dose of 4 mg/kg followed by 2 mg/kg once a week. The man tolerated the second-line treatment well and his disease stabilised. However, he experienced a disease progression, and persisting EGFR L858R and T790M mutations were noted at a lower allele frequency with absence of HER2 mutation and amplification. His treatment with trastuzumab and osimertinib was changed to a platinum-based combination chemotherapy. Author comment: "We report a case of a patient with EGFR-mutated lung adenocarcinoma who developed a complex resistance profile: T790M mu-tation, HER2 mutation and HER2 amplification after first-line EGFR-TKI." Ralki M, et al. Triple Trouble: A Case of Multiple Resistance Mechanisms after First Generation EGFR-TKI in NSCLC. Case Reports in Oncology 12: 625-630, No. 2, May-Aug 2019. Available from: URL: http://doi.org/10.1159/000502214 803432991 Belgium
0114-9954/19/1778-0001/$14.95 Adis © 2019 Springer Nature Switzerland AG. All rights reserved
Reactions 9 Nov 2019 No. 1778
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