阿美替尼快速改善重症肺腺癌患者1例

Almonertinib Rapidly Improved Severe Lung Adenocarcinoma: A Case Report

摘要: 阿美替尼是我国首个自主研发的第三代表皮生长因子受体–酪氨酸激酶抑制剂(Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitor, EGFR-TKI)，国内外指南推荐其作为EGFR突变晚期非小细胞肺癌(Non-Small Cell Lung Cancer, NSCLC)一线用药。然而，体力状态评分(Performance status, PS) 2~4分且EGFR阳性突变的重症肺腺癌患者应用阿美替尼的疗效数据尚有限。本文报道1例PS 3分的EGFR 19del突变晚期重症肺腺癌并伴有抑癌基因TP53、RB1共突变患者，接受阿美替尼治疗3个月后PS评分降至1分，靶病灶缩小95%以上，未发生3级不良反应，为后续联合治疗创造了条件。提示阿美替尼在功能状态较差且伴TP53/RB1共突变等不利预后因素的EGFR突变重症肺腺癌患者中仍可能具有快速起效价值，值得进一步观察。

Abstract: Almonertinib is the first domestically developed third-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) in China. Both domestic and international guidelines recommend almonertinib as a first-line treatment for EGFR-mutated advanced non-small cell lung cancer (NSCLC). However, efficacy data on almonertinib in severe lung adenocarcinoma patients with a Performance status (PS) score of 2~4 and EGFR-positive mutations remain limited. This case report describes a patient with advanced severe lung adenocarcinoma harboring an EGFR 19del mutation with co-mutations in tumor suppressor genes TP53 and RB1, and a baseline PS score of 3. After 3 months of almonertinib treatment, the PS score improved to 1, target lesions shrunk by more than 95%, and no grade 3 adverse events occurred, thereby creating an opportunity for subsequent combination therapy. These findings suggest that almonertinib may offer rapid therapeutic efficacy in EGFR-mutated severe lung adenocarcinoma patients with poor functional status and adverse prognostic factors such as TP53/RB1 co-mutations, warranting further investigation.