Long-term Disease Control After Probable Endobronchial Small-cell Transformation During Osimertinib Therapy for EGFR-mutant Lung Adenocarcinoma
5 affiliations
- 1First Department of Internal Medicine, Toyama University Hospital, Toyama, Japan
- 2Department of Respiratory and Allergy Medicine, Toyama Red Cross Hospital, Toyama, Japan
- 3Department of Diagnostic Pathology, Toyama Red Cross Hospital, Toyama, Japan
- 4Department of Thoracic Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
- 5Department of Diagnostic Pathology, Toyama Prefectural Central Hospital, Toyama, Japan
Abstract
Background/Aim: Osimertinib provides durable progression-free survival in EGFR-mutant non-small-cell lung cancer (NSCLC), but acquired resistance is inevitable. Histologic transformation to small-cell lung cancer (SCLC) is a recognized resistance mechanism, typically presenting with widespread metastatic disease and a poor prognosis. Optimal post-transformation treatment strategies have not been established.
Case Report: We report a patient with EGFR exon 19 deletion-positive lung adenocarcinoma who achieved prolonged disease control on osimertinib for mediastinal lymph node recurrence before developing a new endobronchial lesion in the left main bronchus. Rigid bronchoscopic resection and temporary airway stenting relieved the critical obstruction. Pathologic examination confirmed SCLC, and immunohistochemistry of both the initial adenocarcinoma and the endobronchial lesion demonstrated concordant p53 over-expression and loss of Rb expression, supporting a clinical diagnosis of probable histologic transformation. The patient was bridged to sequential chemoradiotherapy, followed by successful stent removal and the resumption of osimertinib, resulting in long-term disease control exceeding four years.
Conclusion: An individualized, multidisciplinary approach comprising rigid bronchoscopic resection, temporary airway stenting, chemoradiotherapy, and osimertinib resumption may achieve prolonged disease control in locoregionally confined SCLC arising during osimertinib therapy. Further case accumulation is warranted to establish optimal treatment strategies.
Related
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BibTeX
@article{murayama2026longterm,
title = {{Long-term Disease Control After Probable Endobronchial Small-cell Transformation During Osimertinib Therapy for EGFR-mutant Lung Adenocarcinoma}},
author = {NOZOMU MURAYAMA and MINEHIKO INOMATA and MASAHIRO MATSUMOTO and DAISUKE FURUKAWA and TOMOMI ICHIKAWA and YOSHINOBU MAEDA and HIDEKI SHINNO and YUKO NAKANISHI and SHIN ISHIZAWA},
journal = {In Vivo},
year = {2026},
month = oct,
doi = {10.21873/invivo.14531},
url = {https://doi.org/10.21873/invivo.14531},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Long-term Disease Control After Probable Endobronchial Small-cell Transformation During Osimertinib Therapy for EGFR-mutant Lung Adenocarcinoma
AU - NOZOMU MURAYAMA
AU - MINEHIKO INOMATA
AU - MASAHIRO MATSUMOTO
AU - DAISUKE FURUKAWA
AU - TOMOMI ICHIKAWA
AU - YOSHINOBU MAEDA
AU - HIDEKI SHINNO
AU - YUKO NAKANISHI
AU - SHIN ISHIZAWA
PY - 2026
DA - 2026/10/29
JO - In Vivo
DO - 10.21873/invivo.14531
UR - https://doi.org/10.21873/invivo.14531
AB - Background/Aim: Osimertinib provides durable progression-free survival in EGFR-mutant non-small-cell lung cancer (NSCLC), but acquired resistance is inevitable. Histologic transformation to small-cell lung cancer (SCLC) is a recognized resistance mechanism, typically presenting with widespread metastatic disease and a poor prognosis. Optimal post-transformation treatment strategies have not been established. Case Report: We report a patient with EGFR exon 19 deletion-positive lung adenocarcinoma who achieved prolonged disease control on osimertinib for mediastinal lymph node recurrence before developing a new endobronchial lesion in the left main bronchus. Rigid bronchoscopic resection and temporary airway stenting relieved the critical obstruction. Pathologic examination confirmed SCLC, and immunohistochemistry of both the initial adenocarcinoma and the endobronchial lesion demonstrated concordant p53 over-expression and loss of Rb expression, supporting a clinical diagnosis of probable histologic transformation. The patient was bridged to sequential chemoradiotherapy, followed by successful stent removal and the resumption of osimertinib, resulting in long-term disease control exceeding four years. Conclusion: An individualized, multidisciplinary approach comprising rigid bronchoscopic resection, temporary airway stenting, chemoradiotherapy, and osimertinib resumption may achieve prolonged disease control in locoregionally confined SCLC arising during osimertinib therapy. Further case accumulation is warranted to establish optimal treatment strategies.
SN - 0258-851X
SN - 1791-7549
ER -