The combination of camrelizumab and apatinib obtained ongoing partial remission for a patient with osimertinib-resistant non-small cell lung cancer: Case report

Abstract

Extensive clinical studies have indicated that the epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) can significantly improve the survival rate of patients with EGFR-mutation–positive malignancies. However, acquired resistance to the third-generation EGFR-TKI osimertinib is an intractable obstacle for many clinical oncologists. The resistance mechanism of osimertinib is very complicated, and the individual treatment varies greatly. We present the case of a 76-year-old woman with advanced non-small cell lung cancer (NSCLC) with EGFR L858R mutation, as well as multiple lung metastases and multiple liver metastases. The patient’s lung lesions progressed after almost 2 years of treatment with Osimertinib. Due to poor physical condition, she could not tolerate chemotherapy or invasive examination. A next-generation sequencing (NGS) panel of a plasma sample showed missense mutations of KRAS (G12S), MET (D1028Y), AR (S697P), LRP1B (S2662C) with allelic frequencies of 0.6%, 0.5%, 0.2%, 0.2%, respectively), 2 nonsense mutations [ZNF521 (E307*), MET (Q42*), with allelic frequencies of 0.5%, 0.3%, respectively], and a splicing mutation in FAT1 (c.3266-1G>C) with an allelic frequency of 0.5%. After treatment with camrelizumab (200 mg fortnightly) combined with small dose of apatinib (125 mg qd), the patient’s lung lesions were successfully overcome with significant reduction and necrosis formation. And the patient's symptoms were significantly relieved and was well tolerated. To our knowledge, this is the first report on the successful treatment of such patients. It indicated a promising treatment option in the clinic to the NSCLC with osimertinib resistance.