Non-small cell lung cancer with both EGFR gene L861Q mutation and the first symptom of perforation due to small bowel metastasis: A case report / 肿瘤

ABSTRACT

Objective: To explore the treatment strategy for non-small cell lung cancer patients with both rare mutation (L861Q) of epidermal growth factor receptor (EGFR) gene and the first symptom of perforation due to small bowel metastasis. Methods: The medical records as well as the diagnosis and treatment process of a case of non-small cell lung cancer with both rare EGFR mutation and the first symptom of perforation due to small bowel metastasis were reviewed restropectively, to explore the treatment strategy. Results: The perforation was the first symptom in this non-small cell lung cancer patient with both rare EGFR mutation (L861Q) and small bowel metastasis. After the laparotomy and partial small intestine resection, afatinib was administered orally for 16 days according to the genetic test results until peritoneal effusion and enlarged lesions in the right lung was found, as well as liver, bilateral adrenal, brain parenchymal, vertebral and retroperitoneal lymph node metastases were assessed by CT and MR scan. Progressive disease with eventual death of vomiting occured, and the rescue is invalid. The overall survival time was 110 days after surgery. Conclusion: For non-small cell lung cancer patients with both rare EGFR mutation (L861Q) and small bowel metastasis, the prompt diagnosis and treatment against primary tumor are the keys to improve their prognosis. Rare EGFR mutations are heterogeneous and lack of standard treatment due to the low incidence. Further large-scale prospective randomized controlled studies are needed.