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Vol.51 No.2 contents | Japanese/English |
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- Case Report -
An Autopsied Case of Lung Cancer Which Simultaneously Expressed L858R and T790M Mutations Before Gefitinib Therapy
Fumiko Tokuhashi1, Shinji Sakaguchi1, Kazutoshi Isobe1, Keishi Sugino1, Tsutomu Hatori2, Sakae Homma11Department of Respiratory Medicine, 2Department of Pathology, Toho University Omori Medical Center, Japan
Background. The mutation of T790M epidermal growth factor receptor (EGFR) before EGFR-tyrosine kinase inhibitor (TKI) therapy is extremely rare. Case. A 64-year-old man visited our hospital complaining of bloody sputum and backache. Chest computed tomography (CT) showed a tumor shadow in the right S8, and non-small cell lung cancer was diagnosed by bronchial brushing cytology [cT2aN2M1b (OSS, BRA) stage IV]. Mutations in L858R in exon 21 and T790M in exon 20 were simultaneously detected in his bronchial lavage fluid. He was given gefitinib as 1st line therapy due to his poor performance status. However, he elected to discontinue gefitinib due to the adverse reaction of anorexia after 3 weeks, and he died 3 months after his initial visit. Autopsy showed multiple remote metastases to bone, liver, and adrenal glands. The histopathological classification of the primary lesion was adenosquamous carcinoma. Conclusion. The present case demonstrated that T790M EGFR mutation is not only caused by drug-resistance to EGFR-TKI, but also occurs before treatment.
key words: Lung cancer, Epidermal growth factor receptor, Drug resistance mutation, Tyrosine kinase inhibitor, Gefitinib
Received: July 27, 2010
Accepted: January 11, 2011
JJLC 51 (2): 84-88, 2011
