Neoadjuvant Targeted Therapy with Dacomitinib in a Stage IIIA Non-Small-Cell Lung Cancer Patient Harboring EGFR G719X: A Case Report

Abstract

The effectiveness of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) has been established, leading the NCCN Guidelines to recommend it as a first-line treatment for patients with advanced EGFR mutation-positive non-small cell lung cancer (NSCLC). However, there is still controversy about the use of neoadjuvant TKI treatment for patients with stage III EGFR mutation-positive NSCLC. Here, we firstly report that a stage IIIA lung adenocarcinoma patient benefited from chemotherapy and dacomitinib as neoadjuvant targeted therapy based on EGFR G719X mutation, achieving a pathological downstaging and the chance of radical surgical resection. Our case describes dacomitinib use as neoadjuvant targeted therapy for EGFR positive advanced NSCLC and highlights the application of molecular testing for the better treatment decision making.

Keywords: EGFR G719X; NSCLC; dacomitinib; neoadjuvant targeted therapy; uncommon EGFR mutations.

Figure 1

Representative clinical images during the treatment course. (A) Disease time line illustrated the different treatment received by the patient. (B) Radiological evaluation of the primary tumor and lymph nodes both at the baseline and after neoadjuvant therapy.

Figure 2

The photograph and hematoxylin and eosin (HE) staining for the lesions. (A) The photograph shows the lesion in the upper right lobe of the lung that was removed during surgery. (B) HE staining (200×) of the lesion in the upper right lobe of the lung following neoadjuvant therapy.