A case of small-cell lung carcinoma with EGFR gene mutation

Background. There are few reports of small-cell lung carcinoma (SCLC) with epidermal growth factor receptor (EGFR) gene mutation and the optimal treatment with EGFR-tyrosine kinase inhibitor (EGFR-TKI) for such patients has not yet been established. Case. A 74-year-old woman with dyspnea was referred to our hospital. A chest X-ray showed left pleural effusion and the mediastinum had shifted to the right. A chest CT image after drainage of her pleural effusion revealed a mass in the left lower lobe with destruction of the spine and ribs, and multiple other lesions (cT4N2M1b). The cytological diagnosis of SCLC was confirmed from pleural effusion specimens. Since SCLC is uncommon in non-smoking patients, we performed screening for EGFR mutations which revealed the presence of an exon 18 replacement mutation (G719C). Although first-line chemotherapy with carboplatin and etoposide was initially effective, her general condition worsened due to disease progression. Gefitinib was tried as a second-line therapy, but it was ineffective. Subsequent chemotherapy with amrubicin was also ineffective and the patient died. Conclusion. We encountered a case of SCLC with EGFR gene mutation in a non-smoker. The efficacy of EGFR-TKI for EGFR-mutated SCLC should be investigated further.