ESMO Asia Congress 2022

Abstract YO25

Case summary

Background: the incidence of brain metastasis(BMs) in Asian EGFR mutant non-small cell lung cancer (NSCLC) patients is about 70%. Unfortunately, the efficiencies of the first- and second-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) in BMs were unsatisfied. As we all know, The curative effect of L858R is wores than that of 19Del. Herein, we reported a long-term survival case by the third generation EGFR-TKIs in patient with L858R and BMs.

Methods: Case Presentation

Results:

A 55-year-old female patient with a history of hypertension presented in February 2016 due to headache, vertigo, and vomiting for one week. The diagnosis indicated stage ⅣB (cT2NxM1c) left lung adenocarcinoma with bilateral lung metastasis, BMs and bone metastasis. The patient received whole-brain radiation therapy and 1 cycle cisplatin/pemetrexed chemotherapy treatment. Then gene sequencing result showed a point mutation at exon 21(L858R), and she started first-generation EGFR TKI icotinib 125mg TID for 25 months from May 2016 until her left lung lesions and bone metastasis progressed.

Then the EGFR testing showed a T790M mutation, and she began aumolertinib 110mg Qd on June 28th 2018. The best curative effects of lung lesions reached PR and bone metastasis reached CR, her BMs had a persistent cystic lesion. It is worth noting that no obvious adverse events observed. This patient maintained this treatment for 33 months until progression.

After progression , gene detection showed L858R mutation in exon 21, TP53 mutation, KRAS-Amplified, EGFR-Amplified, and YES1-Amplified. After a multi-disciplinary team discussion, in May 2021, the patient received aumolertinib 110mg QD plus bevacizumab 500mg Q3W (the dose of bevacizumab was adjusted considering her history of hypertension). This “A+T” treatment region kept SD until now for more than 14 months.

Conclusions: We reported a 55-year-old female patient survived for more than 77 months. As we know, This case is the longest survival time reported patient with L858R and BMs so far. This case proved aumolertinib may be a good choice for T790M exon 21(L858R) NSCLC patients, especially with brain metastasis.