非小细胞肺癌EGFR-TKI耐药后转化为小细胞肺癌2例

摘 要 表皮生长因子受体-酪氨酸激酶抑制药 (EGFR-TKI) 治疗晚期非小细胞肺癌 （NSCLC）的耐药机制逐渐明了，其中小细胞肺癌（SCLC）转化引发了学者极大关注。本文详细报道2例女性EGFR基因19外显子缺失突变肺腺癌患者，在EGFR-TKI靶向治疗耐药后伴随血清神经元特异性烯醇化酶（NSE）水平的显著升高；同时，二次活检发现小细胞肺癌（SCLC）的转化，予以标准SCLC化疗方案治疗有效。提示医生应考虑NSCLC EGFR-TKI 治疗失败后 SCLC 转化的可能，并重视NSE动态监测及二次活检病理分析的重要性。

Transformation of Non small Cell Lung Cancer to Small Cell Lung Cancer after EGFR TKI Resistance in Two Patients

ABSTRACTThe genetics mechanisms of drug resistance in non small cell lung cancer (NSCLC) patients treated with epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI) were revealed gradually, and one of them was the transformation of NSCLC to small cell lung cancer (SCLC), which raised much attention of experts. Two cases of lung adenocarcinoma women with relapsed EGFR exon 19 deletion treated with EGFR-TKI were comprehensively reported, which were with poor response and rapid increase of serum neuron specific enolase (NSE) after EGFR-TKI resistance. Meanwhile, the second biopsy identified the pathological transformation to SCLC that was sensitive to standard SCLC treatment. The two cases highlighted the possibility of SCLC transformation of NSCLC after the poor response to EGFR-TKI therapy, and suggested the importance of NSE dynamic monitoring and the second biopsy pathological analysis.