Treating pulmonary blastoma with EGFR tyrosine kinase inhibitor - a rare case report

Pulmonary blastoma (PB) is a rare primary lung malignancy, comprising 0.25-0.5% of all primary lung tumors. This article reports a 60-year-old female patient with PB, who presented progressive dyspnea with presence pleural effusion when admitted to the hospital. A mass in the right upper lung lobe was observed. The diagnosis of PB was confirmed by histological, pathological, and immunohistochemistry analyses of the biopsy samples. EGFR mutation (L858 in exon 21) was detected. Accordingly, an oral EGFR inhibitor, Iressa, was administered at 250 mg daily in combination with chemotherapy. The symptoms of dyspnea improved significantly, and the chest CT examination performed at 1- and 2-month after therapy showed disappearance of pleural effusion. The disease was stable according to the Response Evaluation Criteria in Solid Tumors (RECIST). The patient achieved progression-free survival (PFS) for 16 months, followed by an observation of a new mass in the right upper lung lobe. CT-guided biopsy of the new lesion was performed. The same EGFR mutation was detected; no T790M mutation or c-MET amplification was found. The second-and third-line treatments, DP (docetaxel + cisplatin) and GC (Gemcitabine + carboplatin), were provided in combination with Iressa, and pulmonary CT scan still revealed progression of the disease. The fourth-line treatment (Irinotecan, etoposide and Iressa) was provided, and chest CT showed partial remission according to the RECIST criteria. The patient achieved another 6 months of PFS. However, the patient's condition was then progressed rapidly and died due to respiratory failure at week 3 after administration of the fifth-line chemotherapy (topotecan and Iressa). The overall survival (OS) of the patient was 28 months.