PDF(Pubmed)
Abstract：
Paraneoplastic eosinophilia is a rare complication observed in 1% solid tumor cases and appears to have tumor type-dependent prognostic impact, in which the increased eosinophil count was generally associated with unfavorable prognosis. In the English literature, more than 20 patients have been reported of eosinophilia associated with primary non-small cell lung cancer (NSCLC) at diagnosis, all of whom underwent either surgery, chemotherapy, or symptomatic therapy. Herein, we describe clinical course a stage IV NSCLC patient with paraneoplastic eosinophilia and leukocytosis and receiving targeted therapy. A 64-year-old male former smoker was diagnosed with lung adenocarcinoma harboring EGFR L858R mutation and MET amplification. Blood eosinophilia was manifested at diagnosis and confirmed to be paraneoplastic by eliminating other potential causes. The disease progressed rapidly within a month on EGFR inhibitor icotinib and then within three months on icotinib plus crizotinib after rapid response within the first month. A multi-target kinase inhibitor anlotinib was added, and the disease progressed one month later despite initial self-reported asymptomatic high-performance status. The patient was lost to subsequent follow-ups. Radiographic evaluation of disease control or progression coincided with respective distinct alleviation or worsening of eosinophilia. Consistent with previous reports of poor clinical outcome associated with blood eosinophilia, our results suggested a negative prognostic impact in EGFR-/MET-altered NSCLC. This case is, to the best of our knowledge, the first to provide evidence for blood eosinophilia paralleling disease progression in an EGFR- and MET-altered lung adenocarcinoma under targeted therapy, which suggested negative prognostic impact of blood eosinophilia in driver-positive NSCLC.
摘要：
副肿瘤性嗜酸性粒细胞增多是在1%实体瘤病例中观察到的罕见并发症，并且似乎具有肿瘤类型依赖性预后影响。其中嗜酸性粒细胞计数增加通常与不良预后相关。在英国文学中，超过20例患者在诊断时被报道与原发性非小细胞肺癌（NSCLC）相关的嗜酸性粒细胞增多，所有这些人都接受了两种手术，化疗,或对症治疗。在这里，我们描述了一个有副肿瘤嗜酸性粒细胞增多和白细胞增多并接受靶向治疗的IV期NSCLC患者的临床过程.一名64岁的男性前吸烟者被诊断为具有EGFRL858R突变和MET扩增的肺腺癌。血液嗜酸性粒细胞增多在诊断时表现出来，并通过消除其他潜在原因证实为副肿瘤。该疾病在使用EGFR抑制剂埃克替尼的一个月内迅速进展，然后在第一个月内快速反应后，在三个月内使用埃克替尼加克唑替尼。加入多靶点激酶抑制剂安洛替尼，尽管最初自我报告为无症状的高性能状态，但疾病在一个月后进展。患者失去了随后的随访。疾病控制或进展的影像学评估与嗜酸性粒细胞增多的各自明显缓解或恶化相吻合。与以前关于血液嗜酸性粒细胞增多相关的不良临床结局的报道一致，我们的结果提示EGFR-/MET改变的NSCLC对预后有负面影响.这个案子是,据我们所知,首次提供血液嗜酸性粒细胞增多与EGFR和MET改变的肺腺癌在靶向治疗下的疾病进展平行的证据，这表明血液嗜酸性粒细胞增多对驾驶员阳性NSCLC的预后有负面影响。
