Abstract YO31
Case summary
Background:
Aumolertinib and osimertinib are both third-generation, irreversible epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) that were approved for non-small cell lung cancer (NSCLC) patients with EGFR mutation. FLAURA China study showed 3 patients were reported serious adverse events (SAEs) due to pleural effusion. Previous studies reported some cases that were resistant to osimertinib and switched to aumolertinib. High-dose aumolertinib demonstrated a favourable efficacy in advanced NSCLC with brain metastases in the ACHIEVE study, whereas the efficacy of high-dose aumolertinib in NSCLC patients with pleural metastases and pleural effusions is unclear.
Methods:
Here we report a long-term survival case administered osimertinib as 1st-line treatment, then followed by 2nd-line treatment with high-dose aumolertinib plus anlotinib after progressive disease (PD).
Case report:
A 61-year-old male presented with productive cough and chest tightness of 3 months and 1 month duration, respectively. Chest CT showed a mass in the lower lobe of the right lung, and multiple nodules in both lungs. PET-CT revealed pleural metastases. The patient was diagnosed with stage Ⅳ (cT2N0M1) right lung adenocarcinoma with pleural metastases, and genetic testing confirmed EGFR 19Del mutation. Patient was treated with osimertinib 80mg QD as 1st-line therapy. The best curative responses were partial response (PR) for the lung lesions after 5 weeks of treatment. However, CT showed progression of the primary lung lesion and pleural effusion on the right side, the PFS1 was 17 months, no other new metastatic lesion was observed. Osimertinib was discontinued and high-dose of aumolertinib plus anlotinib was chosen as 2nd-line treatment due to the patient's refusal to undergo chemotherapy, leading to stable disease (SD) after 1 month, the PFS2 was 24 months.
Conclusion:
This case indicated that the use of high-dose aumolertinib (165 mg daily) plus anlotinib represents a promising approach for the treatment of osimertinib-resistant advanced lung adenocarcinoma with pleural metastases and pleural effusions.