机构：[1]Department of Thoracic Surgery and Institute of Thoracic Tumor, West China Hospital, Sichuan University, Chengdu, China.四川大学华西医院[2]Department of Medicine, University of California San Diego, La Jolla, CA, USA.[3]Medical Oncology Unit, Department of Human Pathology "G. Barresi", University of Messina, Messina, Italy.
Circulating tumor DNA (ctDNA) is receiving more and more attention for its role in tumor screening and disease surveillance in cancer patients. However, it is unclear whether ctDNA can be used to predict recurrence and metastasis in patients after radical resection due to the resulting lower tumor burden. The published literature on postoperative ctDNA levels is also currently limited.In this article, we report a rare case in which ctDNA accurately predicted relapse, disease progression and mechanism of resistance to epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) in adjuvant setting in an EGFR-mutated lung adenocarcinoma patient. The 49-year-old male patient was a current smoker and denied any family history. Chest computed tomography (CT) scans revealed a 5.7×4.3 mass in the left upper lobe. He received adjuvant gefitinib after surgery for a stage IIIB (pT3N2M0) pulmonary adenocarcinoma. The ctDNA detection showed that the EGFR exon 19 deletion (EGFR del19) gene mutation frequencies decreased gradually and even disappeared. However, 8 months after the operation, the EGFR del19 mutation re-emerged in the blood, accompanied by a newly emerged solitary nodule (2 mm) that was later confirmed to be metastatic. Soon afterward, ctDNA detection revealed the EGFR T790M mutation, and the mediastinal lymph nodes rapidly enlarged. The patient's treatment was switched to Osimertinib and the ctDNA detection results showed the EGFR T790M gene mutation frequencies steadily decreased to zero. During the treatment period, ctDNA detection accurately predicted each change in disease burden and revealed genotype alterations. The patient ultimately developed severe metastases in the liver after developing resistance to Osimertinib.This report suggests that ctDNA help monitor disease recurrence and identify genotypes in patients undergoing postoperative adjuvant EGFR-TKI therapy. More clinical researches are needed to support ctDNA is a promising tool for predicting disease progressive.2022 Translational Lung Cancer Research. All rights reserved.
基金：
Basic Science
Program (grant number 2019YJ0077 to LF), the Science
and Technology Department of Sichuan Province, NSFC
(grant number 81672311 to LLX), and the 1.3.5 Project for
Disciplines of Excellence of West China Hospital, Sichuan
University (grant number ZYGD18021 to LLX).
语种：
外文
PubmedID：
中科院(CAS)分区：
出版当年[2022]版：
大类|3 区医学
小类|3 区呼吸系统4 区肿瘤学
最新[2023]版：
大类|2 区医学
小类|3 区肿瘤学3 区呼吸系统
第一作者：
第一作者机构：[1]Department of Thoracic Surgery and Institute of Thoracic Tumor, West China Hospital, Sichuan University, Chengdu, China.
共同第一作者：
通讯作者：
通讯机构：[1]Department of Thoracic Surgery and Institute of Thoracic Tumor, West China Hospital, Sichuan University, Chengdu, China.[*1]Department of Thoracic Surgery and Institute of Thoracic Tumor, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu 610041, China
推荐引用方式(GB/T 7714)：
Zeng Zhen,Liu Chengwu,Deng Senyi,et al.Circulating tumor DNA accurately predicts disease progression and genotype alterations in postoperative adjuvant EGFR-TKI resistance: a case report[J].Translational lung cancer research.2022,11(9):1961-1966.doi:10.21037/tlcr-22-562.
APA：
Zeng Zhen,Liu Chengwu,Deng Senyi,Lin Feng,Husain Hatim...&Liu Lunxu.(2022).Circulating tumor DNA accurately predicts disease progression and genotype alterations in postoperative adjuvant EGFR-TKI resistance: a case report.Translational lung cancer research,11,(9)
MLA：
Zeng Zhen,et al."Circulating tumor DNA accurately predicts disease progression and genotype alterations in postoperative adjuvant EGFR-TKI resistance: a case report".Translational lung cancer research 11..9(2022):1961-1966
