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Carlos Carracedo Gonzales



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    P3.17 - Treatment of Locoregional Disease - NSCLC (Not CME Accredited Session) (ID 983)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.17-14 - A Case of a Patient Harboring an EGFR -T790M Mutation PositiveĀ in Squamous Cell Lung Cancer (ID 12516)

      12:00 - 13:30  |  Presenting Author(s): Carlos Carracedo Gonzales

      • Abstract
      • Slides

      Background

      Actually, the treatment of lung cancer who express driver mutations consist in block this target, the majority of this patients has an adenocarcinoma histology only few of them has the squamous type.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We describe a case report of a 58-year-old female, non smoker, with a persistent cough of 2 months of evolution. On May 2016, the CT scan reported an irregular solid lesion of 72x56mm in right segment 6, infiltration of hilum, pulmonary artery and mediastinal lymph nodes. No extrathoracic disease. Biopsy: squamous cell carcinoma. Since the lesion was considered unresectable, she initiates concurrent ChT-RT (cisplatin / gemzar). After the 4th application, local progression was evidenced. Mutation studies, showed EGFRm Exon 19. She starts treatment with Afatinib (40mg / d) but, after 2 weeks, presented G3 gastrointestinal toxicity, so a dose-adjustment to 30mg / d was performed, G2 dermal toxicity also was reported.

      By december 2016, due to the response obtained, a medial and inferior lobectomy was performed. Pathological report (PR): middle lobe: pneumonitis. Lower lobe: squamous carcinoma. T: 3.5cm, G1, LVI (+), parenchymal margin (+).

      A PET / CT scan 4 weeks after the surgery, demonstrating right parahilar hypermetabolic lesion, pleural nodules and subcarinal adenopathy.

      The systemic treatment was restart in January 2017 with erlotinib 150mg /d. A PET / CT control 2 months later just showed slight metabolism in subcarinal adenopathy. She remains asymptomatic until october 2017, when presented aphasia and behavioral alterations. MRI: single left cortico-subcortical lesion of 2.2 x 2 cm with edema and subfalcial herniation. An hypo-fractionated radiotherapy scheme with corticoids was programmed but with minimal benefit. Six weeks after having completed RT (December 2017), greater neurological involvement is evidenced associated with weakness in lower limbs. MRI: lesion of 17.6 x17.3mm with contrast hyper-uptake and edema. CT thorax: no evidence of disease. Considering these findings and clinical deterioration a cerebral metastasectomy was performed. PR: squamous cell carcinoma. EGFRm deletion 19 (+) T790M (+).

      4c3880bb027f159e801041b1021e88e8 Result

      Due to the post-surgery clinical deterioration, the patient did not receive systemic treatment until march 2018, CT scan: multiple subcarinal adenopathies, contralateral pulmonary nodules and a 6mm nodule in the right lobe of the cerebellum. Patient is currently under treatment with osimertinib, with clinical neurological recovery and no respiratory symptoms.

      8eea62084ca7e541d918e823422bd82e Conclusion

      The use of TKI in SQCLC has a benefit in this patients, but the magnitude of this could be lower than adenocarcinoma according with a few series. However, this does not seem to be the case.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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