Salvage Surgery in a Stage IV Lung Adenocarcinoma Patient with Acquired Erlotinib Resistance

Abstract

Background. The majority of lung cancer patients with an epidermal growth factor receptor (EGFR) mutation develop resistance to EGFR-tyrosine kinase inhibitors within 1 year. Case. A 70-year-old female with an abnormal shadow in the right lower lobe was referred to our hospital in October 2006 and diagnosed with lung adenocarcinoma harboring an EGFR L858R mutation, stage IV (T1aN0M1b, BRA). She was treated with erlotinib as fourth-line chemotherapy starting in March 2009. Although she achieved a stable disease status for approximately 2-1/2 years, the patient exhibited cancer regrowth at the site of the primary tumor as the serum level of CEA became elevated. We then performed right lower lobectomy as salvage surgery. An EGFR T790M resistance mutation was found in the resected specimen. The patient is still alive 15 months after surgery, although a solitary brain metastasis has developed. Conclusions. Salvage resection of tumors with acquired resistance to EGFR-TKI is therefore considered to be an acceptable option for salvage treatment.