Case report: Management of Progressive Lung Cancer Patients after First-Line EGFR Tyrosine Kinase Inhibitor Therapy

Sahrun Sahrun, Laksmi Wulandari


Abstract views = 865 times | downloads = 1184 times


Various tyrosine kinase inhibitor (TKI) drugs have been widely used as therapy for cancer that has EGFR mutations, or abnormal EGFR activation. However, patients who have a mutation in the gene that activates EGFR only benefit from EGFR-TKI therapy for less than one year, because after that resistance occurs. In the management of patients according to NCCN 2017, patients who experience progress after receiving TKI as the first-line therapy must undergo an examination to identify the presence of T790M mutation. If the T790M mutation is positive, the choice of therapy that needs to be provided is the third generation (Osimertinib). Many recent studies have proved the significance of the effectiveness and response of Osimertinib therapy in lung cancer with EGFR T790M mutation. We reported the management of a pulmonary adenocarcinoma patient with positive EGFR mutation who had received first-line EGFR TKI who had progressive disease and T790M mutation in Dr. Seotomo Hospital. The patient finally received Osimertinib through an Early Access Program with a therapeutic response that improved significantly.


Tyrosine kinase inhibitor; TKI resistance; T790M mutation; progressive disease; osimertinib

Full Text:



Arief N (2009). Kegawatdaruratan paru, departemen pulmonologi dan ilmu kedokteran respirasi FKUI RS PERSAHABATAN, Universitas Indonesia

Blom JW, Doggen CJ, Osanto S, et al (2005). Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 293, 715-722. Available from https://www.ncbi.nlm.nih. gov/pubmed/157019 13. Accessed September 13, 2018

Brzezniak C, Oronsky B, Carter CA, et al (2017). Superior vena cava syndrome in a patient with small-cell lung cancer: A case report. Case Rep Oncol 10, p 252-257

Carson JL, Kelley MA, Duff A, et al (1992). The clinical course of pulmonary embolism. N Engl J Med 326, p 1240-1245. Available from https://www.ncbi 1560799. Accessed September 11, 2018

Ciardiello F, Tortora G (2008). EGFR Antagonists in Cancer Treatment. N Engl J Med 358, 1160-1174

David SE, Douglas EW, Dara LA, et al (2017). Non-Small Cell Lung Cancer, Version 5, Clinical Practice Guidelines in Oncology. J National Comprehensive Cancer Network (NCCN) 15, 504-535

Ettinger DS, Akerley W, Bepler G, et al (2010). Non - small cell lung cancer clinical practice guidelines in oncology. Natl Compr Cancer Netw 8, 740-801

Falanga A (2009). The incidence and risk of venous thromboembolism associated with cancer and nonsurgical cancer treatment. Cancer Investig 27, 105-115. Available from pubmed/19160098. Accessed September 14, 2018

Greene FL, Page DL, Fleming ID, et al (2002). Cancer Survival Analysis. In: AJJ Cancer Staging handbook, 6th Ed. New York, Springer, p 15-25

Huang L, Fu L (2015). Mechanisms of recistance to EGFR tyrosine kinase inhibitors. Acta Pharmaceutica Sinica B 5, 390-401. Available from uk/download/pdf/ 82702660.pdf. Accessed September 12, 2018

Jemal A, Bray F, Center MM, et al (2003). Global cancer statistics. A Cancer Journal Clinicians 61, 69-90

Kosasih, Alvin, Susanto AD, et al (2008). Diagnosis Dan Tatalaksana Kegawatdaruratan Paru Dalam Praktek Sehari-hari, Jakarta, Sagung Seto

Lee AY (2005). Management of thrombosis in cancer: primary prevention and secondary prophylaxis. Br J Haematol 128, p 291-302. Available from pubmed/ 15667530. Accessed 09 10, 2018

Mok TS, Wu YL, Thongprasert S, et al (2009). Gefitinib or carboplatinpaclitaxel in pulmonary Adenokarsinoma. N Engl J Med 361, p 947-57

Nordstrom M, Lindblad B, Bergqvist D, et al (1992). A prospective study of the incidence of deep-vein thrombosis within a defined urban population. J Intern Med 232(2), p 155-160. Availabe from Accessed 09 14, 2018

Parkin DM, Bray F, Ferlay J, et al (2002). Global cancer statistics 2002. A Cancer Journal Clinicians 55(2), p 74-108

Rosell R, Moran T, Queralt C, et al (2009). Screening for epidermal growth factor receptor mutations in lung cancer. N Engl J Med 361, 958-67

Sequist LV, Waltman BA, Dias-Santagata D, et al (2011). Genotypic and histological evolution of lung cancers acquiring recistance to EGFR inhibitors. Sci Transl Med 3, 75ra26

Shinagare AB, Guo M, Hatabu H, et al (2011). Incidence of pulmonary embolism in oncologic outpatients at a tertiary cancer center. Cancer 117, p 3860-6. Available from pmc/articles/PMC3131455/. Accessed September 11, 2018

Socinski MA, Villaruz LC, Ross J (2016). Understanding mechanisms of recistance in the epithelial growth factor receptor in non-small cell lung cancer and the role of biopsy at progression. Oncologist 21, 1-9

Sorensen HT, Mellemkjaer L, Olsen JH, et al (2000). Prognosis of cancers associated with venous thromboembolism. N Engl J Med 343, 1846-50. Available from https://www.ncbi. Accessed September 13, 2018

Thomas A, D’Amico MD, Malcolm M, et al (2004). EGF receptor gene mutation are common in lung cancer from “never smokers” and are associated with sensitivity of tumors to gefinitib and erlotinib.Proceedings of the National Academy of Science 101, 13306-11

WHO (2004). Histological of the tumor of the lung. In: Tumor of the lung-WHO classification

Yang P, Cerhan JR, Vierkan RA, et al (2002). Adenokarsinoma of the lung is strongly associated with cigarette smoking: further evidence from a prospective study of women. American Journal of Epidemiology 156, 1114-1122

Yun C, Mengwasser KE, Toms A V, et al (2008). The T790M mutation in EGFR kinase causes drug recistance by increasing the affinity for ATP. Proc Natl Acad Sci USA 105, 2070-2075. Available from Accessed September 11, 2018


  • There are currently no refbacks.

Copyright (c) 2019 Sahrun Sahrun, Laksmi Wulandari

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Indexed By

View My Stats

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.