case_images: PMC11831635_01
case_images: Representative clinical images. (a) October 2018: baseline imaging before starting gefitinib. Red arrows indicate double lung nodules. (b) November 2018: one month after starting gefitinib; June 2019: PD confirmed by CT. Red arrows indicate the resolution of lung nodule and new nodules, respectively. (c) December 2019: six months after starting osimertinib; October 2020: PD confirmed by CT. (d) December 2020: one and a half months after initiating the combination treatment of afatinib and bevacizumab; January 2021: Bone metastases detected by magnetic resonance imaging. Red arrows indicate the bony destruction to cervical vertebra and thoracic vertebrae.. PD: progressive disease; CT: computed tomography.
case_images: 10.1177_2050313X251319381-fig1.jpg
case_images: PMC11831635_01_10.1177_2050313X251319381-fig1.jpg
case_images: fig1-2050313X251319381
case_images: Unfortunately, in October 2018, the patient experienced disease progression (PD), with multiple metastatic nodules in both lungs as observed on chest CT (Figure 1(a)). During treatment with gefitinib (250 mg qd) (Figure 1(b)), a grade I adverse event (rash) occurred. However, in June 2019, PD was confirmed by CT, showing new lymph nodes in the lungs and increasing serum concentrations of carcinoembryonic antigen (CEA) (Figures 1(b) and 2). However, in October 2020, the patient developed further disease progression, marked by widespread metastatic lung nodules (Figure 1(c)). However, magnetic resonance imaging on January 11, 2021, revealed bone metastases in the cervical vertebra (Figure 1(d)).
case_images: Integrated genomics viewer snapshots illustrating the detected L858R, T790M, cis-C797S, and L718Q mutations in the lung adenocarcinoma tumor of the patient.
case_images: 10.1177_2050313X251319381-fig3.jpg
case_images: PMC11831635_01_10.1177_2050313X251319381-fig3.jpg
case_images: fig3-2050313X251319381
case_images: In November 2020, next-generation sequencing was conducted using panels covering 95 lung cancer-related genes (Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai, China), revealing a complex mutation: EGFR L858R (abundance: 47.13%), EGFR T790M (abundance: 15.06%), EGFR cis-C797S (abundance: 6.90%), and EGFR L718Q (abundance: 8.58%) (Figure 3).