Sequential use of EGFR-tyrosine kinase inhibitors based upon EGFR mutation evolution achieves long-term control in a non-small cell lung cancer patient: a case report

Tyrosine kinase inhibitor (TKI) has greatly improved the survival of non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR)-TKI sensitive mutations. However, TKI resistance constantly occur, although multiple lines different generations TKIs are adopted during progression. For example, in case when T790M, which is most common mechanism first generation TKIs, occurs, alteration to osimertinib (the third TKI) could always be effective. Unfortunately, some cases gradually become resistant even leaving limited therapy choice for clinical practitioners. Few have been reported situation after EGFR tertiary mutations occurred, such as C797S, G724S, etc. Herein, we report evidence that sequential erlotinib, osimertinib, afatinib plus endostar, brigatinib cetuximab, almonertinib, almonertinib achieved long-term control a NSCLC patient demonstrating 19Del/T790M/G724S/cis-C797S evolution response treatment. targeted introduced successful management more than 36 months until now. ctDNA NGS was performed at time important event. The 19Del discovered October 2017, and erlotinib administered 10 PR beginning. Then T790M detected used 9 SD condition. Subsequently, G724S identified remaining loss T790M. Afatinib endostar 1.5 months. PD occurred 6 later emergence cis-C797S. cetuximab chosen lasted 4 best SD. And then were still C797S. Almonertinib, another third-generation TKI, 3 Finally, recurred, whole dose prescribed now 2 side effect acceptable period therapies. Plasma provided information mutation inform appropriate regimen