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  EP1.16 - Treatment in the Real World - Support, Survivorship, Systems Research (ID 206)

  • Event: WCLC 2019
  • Type: E-Poster Viewing in the Exhibit Hall
  • Track: Treatment in the Real World - Support, Survivorship, Systems Research
  • Presentations: 1
  • Now Available
  • Moderators:
  • Coordinates: 9/08/2019, 08:00 - 18:00, Exhibit Hall

  • 32280

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    EP1.16-36 - A Good Intestinal Bacterial Environment Can Reduce the Side Effects of Tyrosine Kinase Inhibitors and Enhance Their Anti-Cancer Effects (Now Available) (ID 511)

    08:00 - 18:00  |  Author(s): Yuji Naito
    • Abstract
    • Slides

    Background
    

    We live in symbiosis with a huge number of microorganisms. Recently, analysis of intestinal bacterial layer has been analyzed in detail in the clinical field by the development of 16S next-generation sequencer. Furthermore, in the lung cancer region, various tyrosine kinase inhibitors are being administered based on gene mutations of EGF receptor of lung cancer.

    In this case, an elderly female patient with EGFR gene mutation who was p-stage IVa at the time of surgery was appropriately treated with anticancer agents after surgery and a long-term survival of 14 years after surgery was obtained with a good intestinal bacterial environment.

    Method
    

    The case was a 78-year-old woman at the first treatment in 2004. There was a tumor in the left S4, pleural effusion was positive, and numerous pleural disseminations were observed during surgery (stage Iva). She was treated with vinorelbine alone, taking into consideration her age. The treatment was successful with caution for hematopoietic disorders. She was treated at home, but in October 2011, she observed an increase in CEA and confirmed that the focal gene mutation was the exon 19 deletion E746-A750 deletion type 1. Then, she had multiple systemic metastasis when CEA rose to 63.0ng/mL, gefitinib was introduced in January 2013. Gefitinib responded dramatically, then CEA dropped to 2.8ng/mL and metastases also became CR with dermatitis as an adverse effect. Although she had paronychia in her extremities, she had no gastrointestinal symptoms such as diarrhea and constipation, and her appetite was good. Since there were no digestive tract symptoms at all, analysis of the intestinal flora was analyzed by the next-generation sequencer.

    Result
    

    The next-generation sequencer has detected no microbiota-disturbing bacteria and balance-regulating bacteria such as Ficarra, fragilis, bifidobacterial, lactic acid bacteria, and equal-producing bacteria.

    Respiratory distress appeared in November 2017 and a large pleural effusion was noted in the left thoracic cavity. At the same time, CEA rose to 25.9 ng/mL. After genetic mutation check of the pleural effusion, the T790M mutation was confirmed. At this point CEA had risen to 87.4 ng/mL. At this time, Osimertinib was administered, and CEA decreased to about 1⁄4 to 20.3 ng/mL in two weeks. There were no digestive tract symptoms such as diarrhea and vomiting constipation, and the appetite was also a normal amount.

    Conclusion
    

    A good intestinal bacterial environment can reduce the side effects of tyrosine kinase inhibitors and enhance their anti-cancer effects.

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