case_images: PMC9432720_01
case_images: Baseline data. (A) Computed tomography (CT) images. (B) Magnetic resonance imaging (MRI). (C) Positron emission tomography-computed tomography (PET-CT) image. (D) Representative histopathological image of the tumor (H&E staining). (E) Next-generation sequencing showed a p.N771-P772insH (c.2311-2312insACC) mutation in EGFR exon 20.
case_images: fphar-13-964606-g001.jpg
case_images: PMC9432720_01_fphar-13-964606-g001.jpg
case_images: F1
case_images: Computed tomography (CT) revealed a 3.2 x 3.1 cm density mass in the lower right lung, multiple lymph node enlargements, bits of pleural effusion on both sides and right pleural metastasis (Figure 1A). Magnetic resonance imaging (MRI) showed scattered enhanced nodules in the brain, with metastasis considered (Figure 1B). Positron emission tomography-computed tomography (PET-CT) suggested active metabolism in the skull and fourth lumbar vertebra, with metastasis considered (Figure 1C). The patient was diagnosed with lung adenocarcinoma by ultrasound-guided lymph node biopsy of the left neck biopsy (Figure 1D). Next-generation sequencing (NGS) of the biopsy specimen indicated that a p.N771-P772insH (c.2311-2312insACC) mutation was in the EGFR gene, and the mutation abundance accounted for 61.1% (Figure 1E).
case_images: Tumor progression of the patient before and after treatment. (A) Representative computed tomography images at various points. CT images revealed lesions in the lower right lung. (B) Magnetic resonance images at various points. PFS, progression-free survival. The timeline of therapies, therapeutic regimens and tumor progression are indicated (top). The tumor is indicated by red arrows. SD, stable disease; PD, progressive disease; PR, partial response.
case_images: fphar-13-964606-g002.jpg
case_images: PMC9432720_01_fphar-13-964606-g002.jpg
case_images: F2
case_images: Tumors (RECIST) 1.1, stable disease (SD) was observed during treatment by chest CT (Figure 2A), and head MRI revealed PR (Figure 2B). The patient received 4 cycles of pemetrexed and carboplatin plus bevacizumab and 3 cycles of maintenance therapy with pemetrexed plus bevacizumab. CT showed an increased mass of solid components in the lower lobe of the right lung, increased multiple lymph nodes, and obviously thickened pleura on both sides (Figure 2A). Therefore, the efficacy evaluation was partial response (PR) according to RECIST 1.1 (Figure 2A). MRI indicated that the patient's brain metastases (BMSs) were constantly stable (Figure 2B). Disease developed again, as shown by a CT scan (Figure 2A) in December 2021.