Multi-line treatment with tyrosine kinase inhibitors enabled in 4-year survival for patient with stage IV lung adenocarcinoma: a case report

The tyrosine kinase inhibitors (TKIs) dramatically improve the clinical outcomes of non-small cell lung cancer (NSCLC) patients. Nevertheless, acquired resistance is practically inescapable in many patients. We recommended a case of lung adenocarcinoma patient, a 59-year-old Chinese woman, who was admitted to hospital with dyspnea after activity for no apparent reason. Computed tomography (CT) scan showed nodules in the anterior segment of the upper lobe of the right lung. This report presented the clinical characteristics, imaging findings, gene mutations, therapeutic regimen and outcome. The patient underwent two biopsies, found both EGFR 19 exon deletion and MET amplification, and EGFR T790M mutation was negative. In addition, ALK was positive according to the Ventana IHC test. She received successively treatment of different EGFR-TKIs and ALK-TKI, namely gefitinib, osimertinib and crizotinib. Although EGFR T790M mutation was negative after blood sample biopsy, but the possibility of tissue positive was not excluded, and the family members refused issue biopsy and chemotherapy, therefore osimertinib was taken as second-line therapy. Although gefitinib has the most lasting effect of 25 months before osimertinib and crizotinib, the disease progressed due to the emergence of acquired resistance. The patient acquired 4-year survival after treated with multi-line TKIs. As far as we know, this was the first reported case that advanced NSCLC patient had achieved such a long survival after multi-line TKIs treatment. Molecular detection and rebiopsy play important roles in the selection of therapeutic regimen for TKIs. The main take-away lesson is that multi-line TKIs treatment was an effective clinical approach for patients with advanced NSCLC.