Case series of small cell lung cancer transformation post tyrosine kinase inhibitor failure

Abstract

Background: Many patients are diagnosed with cancer through the emergency pathway; a route which is associated with inferior outcomes and increased costs to the patient and healthcare system. Lung cancer constitutes the largest proportion of emergency presentations (EP). Small cell lung cancer (SCLC), which represents only 10-15% of all lung cancers, constitutes a disproportionate amount of presentations via the emergency route. Methods: Data was collected retrospectively from four non-teaching hospitals in the United Kingdom over the period of January to December 2016. Only patients with histological confirmation of SCLC were included. We compared the EP population with the population who presented electively in the following categories: -demographicsperformance status -stage at presentation of disease -proportion who proceeded to have chemotherapy -the survival data for this group of patients. Results: 80 patients were identified across four hospitals. 33% (n ¼ 27) presented via the EP route, while 67% (n ¼ 53) presented via the elective referral route.

Histologic Transformation in an EGFR-Mutant Lung Cancer in a Filipino Patient treated with Afatinib: A Case Report and Review of Literature

“…4 This is concordant with data from a 2017 case series done in Malaysia. 6 In this case, resistance developed after 17 months of afatinib therapy, as evidenced by the increase in the number and sizes of the pulmonary and pleural-based nodules on imaging studies.…”

“…9 Other case series have since demonstrated this occurrence, with the transformation to SCLC supported by histomorphology, positive immunohistochemical staining for synaptophysin, chromogranin, or NCAM, and/or retention of the tumor's original EGFR-activating mutation. 3,4,6,8,10,11,12,13,14 Current data suggest that histological transformation to SCLC can occur in up to 14% of EGFR-mutant NSCLC as a mechanism of tyrosine kinase inhibitor resistance. 12 In Asia, a case series done in Shanghai enrolled 87 patients whose lung adenocarcinomas transformed to SCLC after TKI treatment.…”