Does the addition of vascular endothelial growth factor inhibitors to epidermal growth factor receptor-tyrosine kinase inhibitor overcome T790M acquired resistance?

摘要

We previously reported the efficacy of "high-dose erlotinib" (300 mg, alternating days) for refractory brain metastases in a patient with non-small cell lung cancer.1 Six months after the initiation of high-dose erlotinib, progressive disease was observed based on an increase of left pleural effusion and the progression of mediastinal lymph nodes, although the brain metastases remained stable (Figure IA). Cytological examination of the pleural effusion revealed adenocarcinoma cells, and epidermal growth factor receptor (EGFR) gene mutational analysis detected a T790M point mutation in exon 20 and a G719S point mutation in exon 18.