Respuesta profunda y duradera en cáncer de pulmón con mutación L718Q en EGFR, adquirida después de la terapia con osimertinib
Durable clinical benefit from osimertinib therapy in a lung adenocarcinoma patient with L718Q mutation in EGFR
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Respuesta profunda y duradera en cáncer de pulmón con mutación L718Q en EGFR, adquirida después de la terapia con osimertinib.
Rev. colomb. hematol. oncol. [Internet]. 2024 Dec. 5 [cited 2024 Dec. 30];11(2):103-12. Disponible en: https://doi.org/10.51643/22562915.694
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Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
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Las mutaciones tratables en el gen del receptor del factor de crecimiento epidérmico (EGFR) son comunes en el cáncer de pulmón no microcítico (CPNM). La terapia dirigida con inhibidores de la tirosina quinasa (ITK) ha transformado los resultados, pero la resistencia plantea desafíos. El perfil molecular es crucial para el tratamiento personalizado. Descripción del caso: Una mujer de 61 años con CPNM mutado con L858R en EGFR respondió bien inicialmente a osimertinib. Sin embargo, en el mes 26, una biopsia confirmó progresión de la enfermedad con la aparición de la mutación L718Q. Se suspendió osimertinib y se inició quimioinmunoterapia con erlotinib. La paciente logró una supervivencia libre de progresión de 14 meses, demostrando la eficacia de la combinación. Discusión: Se analiza la rareza de la mutación L718Q después de osimertinib en primera línea y su impacto en la resistencia. Hay varios informes de casos que sugieren eficacia modesta con diferentes combinaciones de fármacos, incluyendo otros ITK, quimioterapia o antiangiogénicos. Este es uno de los periodos más largos de supervivencia libre de progresión reportados hasta ahora en este escenario. Además, este caso destaca la importancia de volver a realizar pruebas para objetivos moleculares al progresar en el CPNM mutado con EGFR.
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