Primary Met MET patients with advanced lung cancer patients, chemotherapy is not resistant to switching to Savitinib, PFS is 12 months and good safety

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Wonderful case sharing ~

This case is 68 -year -old male, diagnosed with hyperthyroidism adenocarcinoma with pleura metastasis and bilateral collarbone, internal septum, and dual -pullers lymph node metastasis (CT2BN3M1, IV). The first biopsy of the patient prompts low -division cancer, but due to the lack of specimens, the tissue type was not clear, and the genetic test was not performed. After consultation with Multi -Disciplinary Team (MDT), the patient first accepted the 2 cycle of "paclitaxel+card platinum" chemotherapy. Although the tumor was partially relieved (PR), the patient refused due to the composite fever (IV degree of bone marrow suppression) after chemotherapy. Continue chemotherapy.

In addition, the patient used the second biopsy specimen during chemotherapy for genetic testing, and the results showed that the primary meta was amplified, so it was used for Saviginib for treatment. After that, the patient has maintained the stability of the disease (SD) for a long time, and it has been 12 months old and has good safety. The case was provided by Professor Zhang Lizhen of Henan Cancer Hospital and invited Professor Tang Jingwen, Henan Cancer Hospital to comment.

Profile

▎ Basic situation:

Male, 68 years old, PS 1 point.

In June 2021, he was diagnosed at Henan Cancer Hospital for "coughing with blood for more than 10 days". Local hospitals check CT: The upper left lung-vertical soft tissue masses, consider malignant tumor lesions, and the possibility of hypertrophy of lung cancer. The vertical diaphragm, the left pulmonary and the left pleura nodule shadow, consider metastasis.

Started history: chronic type B virus hepatitis, in the treatment of antiviral treatment; in 2006, internal fracture in Nanyang Orthopedic Hospital was performed, and in 2008, it was forming in Nanyang Orthopedic Hospital through osteoporosis.

Personal history: No special.

▎ Auxiliary inspection:

CT examination: 1. The upper part of the left lung leaf is near the interval of irregular soft tissue lumps, consider the viciousness; 2. The subordinate nodular shadow of the lower lobe, the migration possibility; 3. Consider metastasis; 4. Multiple lymph nodes on the bilateral collarbone, inner diaphragm, and double horny.

Pathological diagnosis: (left lung campaign) non -small cell lung cancer, poor differentiation, immunohistochemistry indicates low -differentiated adenocarcinoma.

Immunization group: CK (+), Vimentin (+), P40 (-), P63 (-), TTF-1 (-), Napsin A (-), Syn (-), CD56 (-), Ki-67, Ki-67 (55%), CD7 (Small Stove+), CD5 (Small Stove+), CGA (-), CK5/6 (-), CK8/18 (+), CD117 (-), CR (Individual+), WT-1 (-), Ber-BP4 (+), TLE-1 (-); Special dyeing: ab (-)/pas (+).

PD-L1 protein detection: PD-L1 (22C3) positive tumor cell TPS <1%, PD-L1 (SP263) positive tumor cell TPS <1%.

MMR protein detection: MLH1 (+), MSH2 (+), MSH6 (+), PMS2 (+).

▎ Diagnosis:

1. Low differentiated glandular cancer with pleura metastasis and bilateral collarbone, internal septum, and double pulmonary lymph node metastasis (CT2BN3M1, IV), PD-L1 TPS <1%, Microfrapenarian Stability (MSS); 2 . Chronic type B viral hepatitis;

3. osteoporosis after forming of the cortbone cement vertebrae.

Provide experts

Professor Zhang Lizhen: The primary MET enlarged advanced lung cancer, the treatment of Savidinib brought 12 months PFS and good safety

MET amplification is one of the main forms of MET pathways. It can be used as a primary drive gene or a secondary -drive gene. The incidence of primary MET amplification in non-small cell lung cancer (NSCLC) is 1%-6%[1].

Patients with hypertrophy of the left lobe with pleura metastasis and bilateral collarbone, bilateral collarbone, inner interval, and double pulmonary lymph node metastasis (CT2BN3M1, IV) patients did not perform genetic testing due to the limited specimen obtained during the first biopsy. According to the 2021 Edition of the China Clinical Oncology Society (CSCO) NSCLC diagnosis and treatment guide [2], the recommendation of the first -line treatment of non -derived gene non -squamous NSCLC in stage IV, this case accepts 2 cycles of "paclitaxel+card platinum" chemotherapy and obtains PR. But unfortunately, the patient refused to continue chemotherapy due to the lack of complications (IV osteoma inhibitory) after chemotherapy.

In order to further clarify the patient's genetic mutation type, the case was conducted secondary biopsy during chemotherapy, and was sent to the octa -basis testing of lung cancer. It was found that it had a high level of MET amplification (CN = 13.8). Savininib is the first high -selective MET inhibitor in my country and the current only approved to be listed. There have been reports that have previously reported that they are effective in the extension of the original meta. Essence After treatment, the patient's tumor has maintained SD and has obtained 12 months of no progressive survival (PFS). And during the treatment, patients had only peripheral edema, and the overall tolerance was good.

From the treatment process of this case, it can be seen that for patients with late -stage NSCLC in the primary MET, the benefit of Savidi targeting therapy is durable and good security. At the same time, this case also indicates that clinicians should pay attention to genetic testing during the treatment of NSCLC patients. If the patient's first biopsy is not enough, a second biopsy should be performed under conditions permit. Only by accurately detecting the driving gene mutations can we better guide the follow -up treatment and make the patient maximize the benefit. Comment expert

Professor Tang Jingwen: The choice of primary MET amplification of advanced lung cancer is limited, and better treatment plans are still needed

The diagnosis of the patient in this case as a hyperthyroidism adenocarcocar on the left lobe with pleura metastasis and bilateral collarbone, inner interval, and double pulmonable lymph node metastasis (CT2BN3M1, IV). Expansion, so it was treated with Savacinib. By the last follow -up, the patient had gained 12 months of PFS, and the safety was good. It can be seen that Savininib may be a long -lasting and secure treatment option for the primary MET amplification NSCLC patients. At present, clinical clinical experience in primary MET amplification is limited, and the success of this case will have a practical guidance value for clinical practice.

In the field of primary MET amplification, a number of studies are currently being explored. Among them, MET-TKI combined immunotherapy has shown certain application prospects. A multi-centered, open label II phase II clinical study [3] evaluated Met-TKI combined immunotherapy NSCLC patients with EGFR wild types. The objective relief rate (ORR) of 50%tumor cells 2+ and GCN≥5) is 25%(ORR), the median PFS is 6.2 months, and the median total survival (OS) is 28 months. Although ORR benefits are limited, PFS and OS show a signal of clinical benefits. However, the samples of the study are limited and still need to be interpreted with caution.

At present, Saverininib combined with Daguyuki treatment of China's EGFR wild type with MET abnormal local advanced or metastatic NSCLC research (Sound) is conducting. It is expected that the research can achieve positive results and be clinically original MET. Augmented treatment brings better choices.

Introduction to case review experts

Tang Jingwen

Chief physician

Deputy Director of Henan Cancer Hospital Traditional Chinese and Western Medicine Integrated Department

Deputy Director of Henan Cancer Traditional Chinese and Western Medicine Integrated Diagnosis and Treatment Center

Vice President of the Zhongjing Medical Research Branch of the China Traditional Chinese Medicine Research Promotion Association

Executive Member of the Professional Committee of Traditional Chinese and Western Medicine Integrated Tumor Integration and Passing therapy of Henan Province

Member of the Tumor Branch of the Chinese Medicine Society

Member of the Chinese Medicine Society of Chinese Medicine Society

Member of the lymphatic committee of the China Anti -Cancer Association

Deputy Chairman of the Henan Anti -Cancer Association Cancer Molecular Medical Committee

Executive Director of Henan Provincial Traditional Chinese Medicine Research Promotion Association

Member of the Tumor Branch of Traditional Chinese and Western Medicine Society in Henan Province

Member of the Henan Anti -Cancer Association Cancer Rehabilitation Professional Committee

Introduction to experts

Zhang Lizhen

Medical Doctor of Medical Physician

Henan Cancer Hospital Traditional Chinese and Western Medicine Integrated Words

Member of the Henan Anti -Cancer Association Cancer Molecular Medical Committee

Member of the Cancer Professional Committee of Henan Provincial Society of Traditional Chinese Medicine

Member of the Tumor Branch of Traditional Chinese and Western Medicine Society in Henan Province

Lanzhou University-University of Miami University of the United States jointly trained a doctorate degree

Prested a project of Henan Provincial Medical Science and Technology Reassuring Program (Joint Co -construction), 1 item of 2021 Henan Province's key R & D and promotion special (scientific and technological research, soft scientific research) and 1 Henan post -doctoral start -up fund

Participate in 7 SCI papers, 1 invention patent, and the highest influence factor of 11.556 in a single article

(Theranostics)

references

[1] .Guo R, et al. NAT Rev Clin Oncol. 2020; 17 (9): 569-587.

[1]. The2021 version of the China Clinical Oncology Society (CSCO) non -small cell lung cancer diagnosis and treatment guide.

[3] .felip e, et al. 2020 WCLC. Abstract FP76.03.

*This article is only used to provide scientific information to medical people, and does not represent the viewpoint of this platform

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