A Case Report of Primary Resistance to EGFR TKI in Lung Adenocarcinoma Due to Coexisting MET Exon 14 Skipping Mutation with Excellent Response to Combination of Gefitinib and Capmatinib

Nirmal Vivek Raut; Siddharth Srivastava; Guarav Dilip Gangwani; Heena Sajid Ali

doi:10.1055/s-0041-1731851

Indian Journal of Medical and Paediatric Oncology, Table of Contents

CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2021; 42(02): 204-207
DOI: 10.1055/s-0041-1731851

Case Report with Review of Literature

A Case Report of Primary Resistance to EGFR TKI in Lung Adenocarcinoma Due to Coexisting MET Exon 14 Skipping Mutation with Excellent Response to Combination of Gefitinib and Capmatinib

Authors

Nirmal Vivek Raut

¹Department of Oncology, Bhaktivedanta Hospital and Research Institute, Thane (East), Maharashtra, India
Siddharth Srivastava

²Department of Molecular Pathology, Neuberg Supratech, Ahmedabad, Gujarat, India
Guarav Dilip Gangwani

³Department of Radiology, Bhaktivedanta Hospital and Research Institute, Thane (East), Maharashtra, India
Heena Sajid Ali

⁴Department of Medical Research Department, Bhaktivedanta Hospital and Research Institute, Thane (East), Maharashtra, India

Abstract

Treatment of nonsmall cell lung cancer (NSCLC) carrying an epidermal growth factor receptor (EGFR) mutation depends on EGFR tyrosine kinase inhibitors (TKIs). However, all patients treated with EGFR TKI eventually develop progressive disease. Approximately, 20% of patients do not respond to EGFR TKIs, which is defined as primary resistance. The prognosis of these patients is similar to NSCLC with nondriver mutations. We report a case of a patient with EGFR exon 21 mutation who rapidly progressed in 15 days on Gefitinib. Next-generation sequencing (NGS) showed a MET exon 14 skip mutation coexisting with EGFR exon 21 mutation, causing primary resistance to EGFR TKI. Based on NGS reports, a treatment combining Gefitinib and Capmatinib, a MET inhibitor, induced a rapid response in the patient, which was sustained at the end of 8 months. This clearly emphasizes the need for comprehensive genomic profiling using NGS over single gene testing.

Keywords

NSCLC - Met Exon 14 Skip - NGS - Capmatinib

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References

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