Nicht kleinzelliges Lungenkarzinom – doppelte Resistenzentwicklung

Zusammenfassung

Erworbene Resistenzen gegenüber Tyrosinkinaseinhibitoren beim nicht kleinzelligen Lungenkarzinom entwickeln sich nach etwa 9 – 12 Monaten. In etwa 60 % der Fälle entstehen diese durch eine sekundäre EGFR-T790 M Resistenzmutation. In dieser Kasuistik wird der Fall einer Patientin mit einer Mutation im EGFR Exon 19 beschrieben. Es entwickeln sich unter TKI-Therapie 2 parallele Resistenzmechanismen. Zum einen eine T790M-Resistenzmutation, zum anderen die Transformation in ein kleinzelliges neuroendokrines Karzinom. Unter der Therapie mit Osimertinib sowie paralleler Chemotherapie mit Carboplatin und Etoposid konnte nach 2 Zyklen eine partielle Remission erzielt werden.

Abstract

Acquired resistances to tyrosine kinase inhibitors in non-small cell lung cancer develop after 9 – 12 month. In 60 % of the cases these resistances arise because of a secondary EGFR-T790 M resistance mutation. This report is describing the case of a patient who developed parallel two different mechanisms of resistance: A T790 M resistance mutation and a transformation into a small cell neuroendocrine cancer. Under therapy with Osimertinib and chemotherapy with carboplatin and etoposide the tumor responsed partially.

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