Lung cancer : journal of the International Association for the Study of Lung Cancer
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Several different acquired resistance mechanisms of EGFR mutant lung adenocarcinoma to EGFR-tyrosine kinase inhibitor (TKI) therapy have been described, most recently transformation to small cell lung carcinoma (SCLC). We describe the case of a 46-year-old female with relapsed EGFR exon 19 deletion lung adenocarcinoma treated with erlotinib, and on resistance, cisplatin-pemetrexed. Liver rebiopsy identified an afatinib-resistant combined SCLC and non-small cell carcinoma with neuroendocrine morphology, retaining the EGFR exon 19 deletion. This case highlights acquired EGFR-TKI resistance through transformation to the high-grade neuroendocrine carcinoma spectrum and that that such transformation may not be evident at time of progression on TKI therapy.
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Thymic carcinoma (TC) is a rare intrathoracic malignancy that it can be invasive and refractory to conventional treatment. Comprehensive genomic analysis evidenced a molecularly distinct subset of thymic carcinoma with high prevalence of c-kit mutation, which may behave as a gastrointestinal stromal tumor (GIST). Here, we present a case report of TC with c-Kit mutation, who has relapsed after exposure to multiple lines of combination chemotherapy, but he has shown an impressive and long lasting response to sunitinib after imatinib failure.
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The histological subtyping of non small cell lung cancer (NSCLC) is important in the selection of the optimal treatment for patients with advanced disease. There are now important differences in the chemotherapy regimens used for squamous and non-squamous cancers. Non-squamous cancers (particularly adenocarcinomas) are also suitable for targeted therapy if the epidermal growth factor receptor (EGFR) genetic mutation is present. Diagnosis is frequently made by fine needle aspiration from lymph node metastases. We have evaluated the adequacy of material obtained by EBUS-TBNA for subtyping of NSCLC. ⋯ EBUS-TBNA samples when made into cell blocks and subjected to a panel of immunohistochemical stains returned adequate tissue for cytological analysis in over 97% of cases, with an NOS rate of 20.8%. We have also shown that cytology specimens are adequate for EGFR mutation testing in over 88% of cases. We conclude that EBUS-TBNA is an accurate diagnostic test both for determining NSCLC subtype and performing EGFR mutation analysis to tailor treatment in lung cancer patients.