Third-Generation TKI Resistance Due to SCLC Transformation: A Case Report and Brief Review

• Main Authors: Chen S, He Y, Liu J, Chen X, Yu J, Li W, Chen B, Sun C, Zhou C
• Format: Article
• Language: English
• Published: Dove Medical Press 2019-12-01
• Series: OncoTargets and Therapy
• Subjects: epidermal growth factor receptor tyrosine kinase inhibitor (egfr-tki); small cell lung cancer (sclc); pathological transformation; resistance
• Online Access: https://www.dovepress.com/third-generation-tki-resistance-due-to-sclc-transformation-a-case-repo-peer-reviewed-article-OTT

Shen Chen,1 Yayi He,1 Juan Liu,2 Xiaoxia Chen,1 Jia Yu,1 Wei Li,1 Bin Chen,1 Chenglong Sun,3 Caicun Zhou1 1Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, Shanghai, People’s Republic of China; 2Department of Respiratory, Shanghai Fourth People Hospital, Shanghai, People’s Republic of China; 3Department of Medical Oncology, Anhui No.2 Provincial People’s Hospital, Anhui, People’s Republic of ChinaCorrespondence: Caicun ZhouDepartment of Medical Oncology, Tongji University Medical School Cancer Institute, Tongji University School of Medicine, No. 507 Zhengmin Road, Shanghai 200433, People’s Republic of ChinaEmail [e-mail]: We reported a case of pathologic type transformed from adenocarcinoma to small-cell lung cancer (SCLC) after being treated with third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI).Materials and methods: The lung cancer pathologic type was transformed from adenocarcinoma to SCLC after the treatment of third-generation EGFR-TKI for 4.3 months. Four times of lung biopsies were conducted at a different time and different lesions. And the patient was treated with a variety of regimens after SCLC transformation, including etoposide combined with carboplatin (EC), irinotecan combined with oxaliplatin (IO), Abraxane, and Apatinib. These treatments got a good response, but quick progression. We also monitored the dynamic change of serum neuron-specific enolase (NSE) and pro-gastrin releasing peptide (Pro-GRP).Results: Adenocarcinoma could transform into SCLC after the treatment of TKI. Tumor cells were heterogeneity, so adenocarcinoma and SCLC could be co-existed. The fluctuation of the NSE was consistent with the response of treatment and the progression of the tumor.Conclusion: Regimens for the primary SCLC were also available for the transformed SCLC, but the duration of the response was short. NSE could be an effective biomarker for dynamic monitoring of the efficacy in SCLC transformation.Keywords: epidermal growth factor receptor tyrosine kinase inhibitor, EGFR-TKI, small-cell lung cancer, SCLC, pathological transformation, resistance