Osimertinib: A Game-Changer in Stage IV EGFR-Driven Lung Cancer.

IF 1 4区 医学 Q3 MEDICINE, GENERAL & INTERNAL
Acta medica portuguesa Pub Date : 2025-09-01 Epub Date: 2025-04-11 DOI:10.20344/amp.22031
Sofia Silva, Joana Duarte, Carla Simão, Margarida Felizardo
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引用次数: 0

Abstract

Lung cancer has a high mortality rate; however, treatment with tyrosine kinase inhibitors targeting specific molecular alterations has significantly improved the survival of patients with advanced or metastatic non-small cell lung carcinoma (NSCLC). EGFR mutations are present in approximately 15% of NSCLC cases. Osimertinib was approved in Portugal by Infarmed (Portuguese Medicines Agency) in 2021 as a first-line therapy for advanced NSCLC with EGFR sensitizing mutations. A 55-year-old man, a former smoker, presented to the Emergency Department with a six-month history of dry cough and dyspnea that had worsened and was now accompanied by fever. Chest CT revealed multifocal pulmonary consolidations that were already present in a scan performed three months earlier. Bronchial biopsies confirmed a diagnosis of lung adenocarcinoma with an EGFR exon 19 deletion. Staging tests revealed stage IV-A disease (pulmonary metastasis and, later, right adrenal metastasis identified on PET-FDG). The patient was started on osimertinib. He was discharged and progressively recovered his baseline general condition, achieving a performance status of 0 and resuming physical activity. Despite the extensive thoracic disease, the patient achieved a complete metabolic response documented on PET-CT five months after initiating therapy, along with significant clinical improvement. Osimertinib effectively inhibits the EGFR signaling pathway and has been established as the firstline treatment for patients with stage IV disease since the FLAURA trial. However, such complete responses are rare and raise further questions about the factors influencing these responses, the optimal duration of therapy in these cases, and the role of circulating tumor DNA in therapy monitoring and discontinuation decisions.

奥西替尼:改变IV期egfr驱动肺癌的游戏规则。
肺癌的死亡率很高;然而,针对特定分子改变的酪氨酸激酶抑制剂治疗显著提高了晚期或转移性非小细胞肺癌(NSCLC)患者的生存率。大约15%的非小细胞肺癌病例中存在EGFR突变。奥西替尼于2021年在葡萄牙被Infarmed(葡萄牙药品管理局)批准作为EGFR致敏突变的晚期NSCLC的一线治疗药物。一名55岁男性,前吸烟者,因六个月的干咳和呼吸困难病史而就诊于急诊科,病情加重,现伴有发烧。胸部CT显示在三个月前的扫描中已经出现了多灶性肺实变。支气管活检证实肺腺癌与EGFR外显子19缺失。分期测试显示IV-A期疾病(肺转移,随后PET-FDG发现右肾上腺转移)。患者开始服用奥西替尼。患者出院并逐渐恢复基线一般情况,达到0分的表现状态并恢复体力活动。尽管患有广泛的胸部疾病,但在开始治疗5个月后,患者在PET-CT上获得了完全的代谢反应,并有显著的临床改善。奥西替尼有效抑制EGFR信号通路,自FLAURA试验以来,已被确立为IV期疾病患者的一线治疗药物。然而,这种完全缓解是罕见的,并提出了进一步的问题,影响这些反应的因素,这些病例的最佳治疗持续时间,以及循环肿瘤DNA在治疗监测和停药决策中的作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Acta medica portuguesa
Acta medica portuguesa MEDICINE, GENERAL & INTERNAL-
CiteScore
1.90
自引率
16.70%
发文量
256
审稿时长
6-12 weeks
期刊介绍: The aim of Acta Médica Portuguesa is to publish original research and review articles in biomedical areas of the highest standard, covering several domains of medical knowledge, with the purpose to help doctors improve medical care. In order to accomplish these aims, Acta Médica Portuguesa publishes original articles, review articles, case reports and editorials, among others, with a focus on clinical, scientific, social, political and economic factors affecting health. Acta Médica Portuguesa will be happy to consider manuscripts for publication from authors anywhere in the world.
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