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Resistance to epithelial growth factor receptor tyrosine kinase inhibitors in a patient with transformation from lung adenocarcinoma to small cell lung cancer: A case report

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First-generation epithelial growth factor receptor tyrosine kinase inhibitors (EGFRTKIs) have markedly improved the treatment of non-small cell lung cancer (nonSCLC) with EGFRsensitive mutations. However, acquired resistance to these drugs was inevitable. The transformation of lung adenocarcinoma to SCLC following treatment with EGFRTKIs is a rare phenomenon that contributes to resistance to EGFRTKIs. The present case concerns a 74yearold man previously diagnosed with and treated for pneumonia; however, this was later pathologically confirmed as lung adenocarcinoma by transbronchial lung biopsy. Deletion of exon 19 of EGFR was identified by nextgeneration sequencing technology. The patient improved markedly when treated with gefitinib, but relapsed after 1 year, with markedly increased serum levels of neuron-specific enolase (NSE). Transformation to SCLC was detected by endobronchial ultrasound transbronchial needle aspiration (EBUSTBNA) rebiopsy, which was negative for the deletion of exon 19 of EGFR. The patient was positive for vimentin expression and refractory to etoposide and cisplatin chemotherapy, and succumbed to the disease 18 months after diagnosis. Transformation of the disease from adenocarcinoma to SCLC may have been due to cancer heterogeneity. Rebiopsy is therefore important in EGFRTKIresistant patients for genetic and histological reevaluation. NSE serum levels may also be useful for detecting early SCLC transformation.
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Document Type: Research Article

Affiliations: Department of Respiratory Medicine, Huashan Hospital, Fudan University, Shanghai 200040, P.R. China

Publication date: January 1, 2017

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  • Oncology Letters is a monthly, peer-reviewed journal, available in print and online, that focuses on all aspects of clinical oncology, as well as in vitro and in vivo experimental model systems relevant to the mechanisms of disease.

    The principal aim of Oncology Letters is to provide the prompt publication of original studies of high quality that pertain to clinical oncology, chemotherapy, oncogenes, carcinogenesis, metastasis, epidemiology and viral oncology in the form of original research, reviews and case reports.
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