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Abstract：
Multiple EGFR-mutant and ALK-mutant lung cancers are rare, and standard treatment has not been established because of the small number of cases. A 79-year-old man was found to harbor nodular shadows in right S1, right S5, and left S3. He was surgically diagnosed with stage IIB (pT3N0M0) EGFR G719X-mutant lung adenocarcinoma in left S3 and stage IA1 (pT1aN0M0) ALK-mutant lung adenocarcinoma in right S5. Owing to the relapse of the EGFR-mutant adenocarcinoma, gefitinib treatment was commenced 3 months postoperatively. The tumor shrank temporarily; however, the nodular shadow in the right S1 and #3a lymph nodes were found to increase in size. He was diagnosed with adenosquamous carcinoma in right S1 and relapsing ALK-mutant adenocarcinoma in #3a lymph node. Gefitinib treatment was continued, but due to a renewed increase in the size of the #3a lymph node, the drug was changed to alectinib 16 months postoperatively. Subsequently, the EGFR-mutant adenocarcinomas were found to increase in left S1 despite the decrease in the #3a lymph node size. Nineteen months after the first surgery, the treatment was changed to gefitinib, and repeated treatment with this drug and alectinib administered every 2 months was continued. This approach enabled 39 months of progression-free survival, and no serious adverse events were observed.
摘要：
多重EGFR突变和ALK突变的肺癌是罕见的，由于病例数量少，标准治疗方法尚未建立。一名79岁的男子被发现在右侧S1、右侧S5和左侧S3有结节状阴影。他被手术诊断为左侧S3的IIB期（pT3N0M0）EGFRG719X突变型肺腺癌和右侧S5的IA1期（pT1aN0M0）ALK突变型肺腺癌。由于EGFR突变腺癌的复发，吉非替尼治疗开始于术后3个月.肿瘤暂时缩小；然而，发现右侧S1和#3a淋巴结的结节状阴影增大。他在右侧S1被诊断为腺鳞癌，在＃3a淋巴结中被诊断为复发的ALK突变型腺癌。继续吉非替尼治疗，但是由于#3a淋巴结的大小重新增加，术后16个月将药物更改为阿来替尼.随后，尽管#3a淋巴结大小减小,但发现左S1中的EGFR突变型腺癌增加.第一次手术十九个月后,治疗改为吉非替尼，继续每2个月使用该药和阿来替尼重复治疗.这种方法实现了39个月的无进展生存期，未观察到严重不良事件.
