非小egfr获得性耐药的肿瘤时空异质性研究之2

此文描述一个日本病例，男63岁egfr外显子19缺失性突变，死于厄洛替尼耐药复发。根据尸检结果，确认在其转移的胰腺和左肾存在小细胞肺癌而没有t790m的突变，而右肾有t790m突变，三处都保留非小egfr外显子19缺失性突变病理特征。这个病例在egfr tki获得性耐药后通过小细胞和t790m两种方式突变。
We herein describe the case of a 63-year-old man who died from relapsed epidermal growth factor receptor gene (EGFR) exon 19 deletion lung adenocarcinoma treated with erlotinib. According to the autopsy results, he was confirmed to have small cell carcinoma without the EGFR T790M mutation in his pancreas and left kidney metastatic specimens, while the adenocarcinoma metastatic lesion in his right kidney had the EGFR T790M mutation; both retained the somatic EGFR exon 19 deletion. We herein report an autopsy case of resistance to an EGFR tyrosine kinase inhibitor via small cell carcinoma transformation and the EGFRT790M mutation in separate metastatic organs.
http://www.ncbi.nlm.nih.gov/pubmed/26424310
EGFR-Mutated Lung Cancer With T790M Acquired Resistance in the Brain and Histologic Transformation in the Lung
© JNCCN—Journal of the National Comprehensive Cancer Network | Volume 11 Number 9 | September 2013
2013年也报道过一个病例：egfr突变的nsclc腺癌病人在特罗凯时断时续的服药后，出现脑转移t790m突变而肺部一个转移点出现鳞癌的病理特征。

虽然是个案但厄洛替尼看来还是比较容易导致一些突变，特别是罕见的向小细胞转化。

但那两处的小细胞化也还保有19突变的情况，不知是否TKI也有效？