Successful treatment of refractory lung adenocarcinoma harboring a germline BRCA2 mutation with olaparib:A case report

摘要

BACKGROUND In recent years,targeted therapy and immunotherapy have become important treatment strategies for patients with non-small cell lung cancer(NSCLC).However,the clinical evidence for successful off-label use of targeted drugs for patients with NSCLC following progression on multiple lines of treatment is still lacking.CASE SUMMARY We describe a 62-year-old male patient with a right lung adenocarcinoma who harbored an EGFR exon 19 deletion mutation.He received gefitinib combined with six cycles of vinorelbine,cisplatin,and recombinant human endostatin as the first-line therapy.Then gefitinib was administered in combination with recombinant human endostatin as maintenance therapy,resulting in a progression-free survival(PFS)of 14 mo.Chemoradiotherapy was added following progression(enlarged brain metastases)on maintenance treatment.Unfortunately,the brain lesions were highly refractory and progressed again after 15 mo,at which time next-generation sequencing(NGS)of 1021 cancer-related genes was performed using peripheral blood to identify potential actionable mutations.NGS revealed that the patient harbored a BRCA2 germline mutation,the EGFR exon 19 deletion mutation disappeared,and no additional targetable genetic variant was detected.Therefore,the patient received olaparib combined with gefitinib and recombinant human endostatin,with a rapid and long-lasting clinical response(PFS=13.5 mo).CONCLUSION This is a rare case of lung adenocarcinoma in a patient with a BRCA2 germline mutation who had long-term benefit from olaparib combination treatment,suggesting that NGS-based genetic testing may render the possibility of long-term survival in NSCLC patients after disease progression.