Lirong Zhang,1 Liye Cai,1 Luwei Ruan,1 Jie Li2 

1Department of Oncology, Affiliated Sanming Integrated Medicine Hospital of Fujian University of Traditional Chinese Medicine, Sanming, Fujian, 365001, People’s Republic of China; 2Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China

Correspondence: Lirong Zhang, Department of Oncology, Affiliated Sanming Integrated Medicine Hospital of Fujian University of Traditional Chinese Medicine, Sanming, Fujian, 365000, People’s Republic of China, Email 15280570565@sohu.com

Abstract: This case report presents a 67-year-old male diagnosed with stage IV lung adenocarcinoma harboring rare EGFR exon 18/20 mutations (Gly719Cys/Ser768Ile) and a concurrent TP53 mutation, complicated by nephrotic syndrome. The scarcity of approved EGFR-TKIs targeting rare EGFR mutations in NSCLC, coupled with nephrotic syndrome-induced renal impairment, hypoalbuminemia, and massive pleural effusion refractory to conventional management, prompted the development of a personalized multimodal approach.A multimodal therapeutic regimen incorporating albumin-bound paclitaxel, intrathoracic perfusion of Endostar (recombinant human endostatin), and traditional Chinese medicine (TCM) was implemented, achieving effective disease control. Notably, the treatment resulted in significant tumor shrinkage (reduction rate: 48.1% by RECIST 1.1), complete resolution of malignant pleural effusion, and marked improvement in nephrotic syndrome parameters. The synergistic effects of targeted chemotherapy, anti-angiogenic therapy, and TCM-based symptom modulation highlight the potential of integrative approaches in managing advanced malignancies with complex molecular profiles and multisystem complications.

Keywords: nephrotic syndrome, lung adenocarcinoma, albumin-bound paclitaxel, endostar, EGFR mutation, malignant pleural effusion