EGFR突变肺腺癌耐药后双靶治疗致急性间质性肺炎1例并文献复习
Acute Interstitial Pneumonia Caused by Dual-Target Therapy in Resistant EGFR-Mutated Lung Adenocarcinoma: A Case Report and Literature Review
摘要: 目的：探究双靶治疗在晚期EGFR突变阳性的非小细胞肺癌患者中的疗效及安全性，不良反应的处理及下一步治疗方案。方法：收集并整理1例携带EGFR敏感突变的晚期肺腺癌患者在TKI耐药后接受双靶向药物联合治疗过程中出现急性间质性肺炎的临床资料，包括患者的基本信息、病史、临床表现、辅助检查、治疗经过及转归；同时，利用PubMed检索国内外相关文献对类似病例的报道及研究进展进行系统分析。结果：患者在应用伏美替尼联合克唑替尼靶向治疗3个月后发生急性间质性肺炎，及时停用靶向药物并给予全身糖皮质激素治疗1周后病情好转，后线加用全身化疗及小分子多靶点药物，取得生存获益，OS为60个月。结论：针对晚期EGFR突变阳性的NSCLC患者，在二线靶向治疗耐药后选择双靶治疗方案可能会引发严重的药物相关间质性肺疾病。因此，我们需要及时识别、调整靶向药物种类或剂量并进行积极对症支持，这对于提高患者后续生存质量至关重要。
Abstract: Objective: To investigate the efficacy and safety of dual-targeted therapy in patients with advanced EGFR mutation-positive non-small cell lung cancer (NSCLC), as well as the management of adverse reactions and next-step treatment strategies. Methods: We collect and organize the clinical data of a case of advanced lung adenocarcinoma harboring an EGFR-sensitive mutation who developed drug-induced interstitial lung disease (DI-ILD) during dual-targeted combination therapy following TKI resistance, including demographic characteristics, medical history, clinical manifestations, auxiliary examinations, treatment course, and outcomes; concurrently, conduct a systematic analysis of domestic and international literature on similar reported cases and research advances using PubMed. Results: The patient developed acute interstitial pneumonia three months after initiation of furmonertinib combined with crizotinib targeted therapy. Immediate discontinuation of targeted agents and administration of systemic glucocorticoids for one week resulted in clinical improvement. Subsequent-line therapy integrating systemic chemotherapy and a small-molecule multi-target agent provided survival benefits, achieving an overall survival (OS) of 60 months. Conclusion: For patients with advanced EGFR mutation-positive NSCLC, the selection of dual-targeted therapeutic regimens after resistance to second-line targeted therapy may precipitate severe DI-ILD. Therefore, prompt recognition, adjustment of targeted agent types or dosages, and implementation of aggressive supportive measures are required to optimize post-treatment quality of life, which is critical for long-term clinical outcomes.
文章引用：张彩, 肖玉婷, 毕焕焕, 易冰倩, 周银雪, 李鑫慧, 杨子艺, 徐博文, 余西, 孙家兴. EGFR突变肺腺癌耐药后双靶治疗致急性间质性肺炎1例并文献复习[J]. 临床医学进展, 2025, 15(4): 2504-2512. https://doi.org/10.12677/acm.2025.1541206

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