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Sixty-seven patients whose lung cancer changed into small-cell carcinoma were followed across eight hospitals. The change came about a year and a half after diagnosis, chemotherapy worked well and immunotherapy did not work at all.
Patients with EGFR-mutant small-cell lung cancer and other high-grade neuroendocrine carcinomas were identified retrospectively at eight institutions. Sixty-seven patients were included, with exon 19 deletion in 69%, L858R in 25% and other mutations in 6%. At initial diagnosis 58 had non-small-cell lung cancer and nine had small-cell or mixed histology; all but those nine received one or more EGFR inhibitors before transformation. Median time to transformation was 17.8 months. After transformation, platinum and etoposide and taxanes yielded high response rates, but none of 17 patients who received immunotherapy responded. Median overall survival since diagnosis was 31.5 months and since transformation 10.9 months. Of 59 patients genotyped at transformation, all maintained their founder EGFR mutation and 15 of 19 previously T790M-positive cases were T790 wild-type. Other recurrent mutations included TP53, RB1 and PIK3CA, and central nervous system metastases were frequent after transformation.
It is the practical guide to what to do after transformation: treat it as small-cell lung cancer with platinum and etoposide, expect central nervous system disease, and do not expect a checkpoint inhibitor to help.
Shares Histologic transformation, RB1, Lineage plasticity & neuroendocrine transformation, Resistance routes: how a blocked pathway comes back.
Shares EGFR T790M, Histologic transformation, RB1, Lineage plasticity & neuroendocrine transformation.
Shares Histologic transformation, RB1, Lineage plasticity & neuroendocrine transformation, Resistance routes: how a blocked pathway comes back.
Shares EGFR L858R, EGFR T790M, EGFR exon 19 deletion, Resistance routes: how a blocked pathway comes back.
Shares EGFR T790M, Histologic transformation, Lineage plasticity & neuroendocrine transformation, Resistance routes: how a blocked pathway comes back.
Shares EGFR T790M, Resistance routes: how a blocked pathway comes back, Drug resistance (primary and acquired), Comprehensive genomic profiling.
Shares EGFR T790M, Resistance routes: how a blocked pathway comes back, Drug resistance (primary and acquired), Memorial Sloan Kettering Cancer Center.
Shares EGFR L858R, EGFR T790M, EGFR exon 19 deletion, EGFR.