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已发表论文
手术切除的EGFR外显子20插入突变型非小细胞肺癌患者接受Sunvozertinib减量后出现脑转移瘤 flare现象
Authors Yan W , Yang N, Wang G, Bao W, Liang Q, Lv T, Ye M , Zhang F, Yin J
Received 5 August 2025
Accepted for publication 8 November 2025
Published 8 December 2025 Volume 2025:18 Pages 1347—1352
DOI https://doi.org/10.2147/OTT.S558460
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Prof. Dr. Gaetano Romano
Wenjie Yan,1 Nan Yang,2 Guoxin Wang,1 Wei Bao,3 Quan Liang,4 Tangfeng Lv,1 Mingxiang Ye,1 Fang Zhang,1 Jie Yin1
1Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People’s Republic of China; 2Department of Thoracic Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People’s Republic of China; 3Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People’s Republic of China; 4Department of Radiology and Medical Imaging Center, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People’s Republic of China
Correspondence: Jie Yin, Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, #305 East Zhongshan Road, Nanjing, 210002, People’s Republic of China, Email yinjie506@163.com Fang Zhang, Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, #305 East Zhongshan Road, Nanjing, 210002, People’s Republic of China, Email zhangfanglab@163.com
Abstract: Therapeutic options for NSCLC with epidermal growth factor receptor exon20 insertions (EGFR ex20ins) are limited. Sunvozertinib is a novel orally EGFR inhibitor that has been approved to treat EGFR ex20ins NSCLC at second line setting. Herein, we reported an unexpected therapeutic outcome of first-line sunvozertinib treatment in a patient with stage IIIB EGFR ex20ins-positive lung adenocarcinoma (T1cN3M0). We found three months of sunvozertinib neoadjuvant treatment led to remarkable shrinkage of the primary tumor and downstaged N3 metastatic disease. A radical resection was scheduled after careful evaluation. Histological assessment of the resected tumor and lymph nodes showed a complete pathologic response. The patient was recommended to continue sunvozertinib as an adjuvant therapy, whereas he developed brain metastasis within three months after surgery. We proposed that the brain metastasis occurred as a result of sunvozertinib dose de-escalation-induced disease flare. Rechallenge with adequate dosage of sunvozertinib led to a rapid shrinkage of the brain metastasis. Our case highlighted the feasibility of sunvozertinib neoadjuvant therapy in EGFR ex20ins-positive NSCLC patient with locally advanced disease. Importantly, adjuvant therapy using an adequate dosage of sunvozertinib is pivotal to prevent disease flare and tumor recurrence.
Keywords: EGFR ex20ins, sunvozertinib, neoadjuvant therapy, downstaging, disease flare
1Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People’s Republic of China; 2Department of Thoracic Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People’s Republic of China; 3Department of Pathology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People’s Republic of China; 4Department of Radiology and Medical Imaging Center, Jinling Hospital, Nanjing University School of Medicine, Nanjing, People’s Republic of China
Correspondence: Jie Yin, Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, #305 East Zhongshan Road, Nanjing, 210002, People’s Republic of China, Email yinjie506@163.com Fang Zhang, Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, #305 East Zhongshan Road, Nanjing, 210002, People’s Republic of China, Email zhangfanglab@163.com
Abstract: Therapeutic options for NSCLC with epidermal growth factor receptor exon20 insertions (EGFR ex20ins) are limited. Sunvozertinib is a novel orally EGFR inhibitor that has been approved to treat EGFR ex20ins NSCLC at second line setting. Herein, we reported an unexpected therapeutic outcome of first-line sunvozertinib treatment in a patient with stage IIIB EGFR ex20ins-positive lung adenocarcinoma (T1cN3M0). We found three months of sunvozertinib neoadjuvant treatment led to remarkable shrinkage of the primary tumor and downstaged N3 metastatic disease. A radical resection was scheduled after careful evaluation. Histological assessment of the resected tumor and lymph nodes showed a complete pathologic response. The patient was recommended to continue sunvozertinib as an adjuvant therapy, whereas he developed brain metastasis within three months after surgery. We proposed that the brain metastasis occurred as a result of sunvozertinib dose de-escalation-induced disease flare. Rechallenge with adequate dosage of sunvozertinib led to a rapid shrinkage of the brain metastasis. Our case highlighted the feasibility of sunvozertinib neoadjuvant therapy in EGFR ex20ins-positive NSCLC patient with locally advanced disease. Importantly, adjuvant therapy using an adequate dosage of sunvozertinib is pivotal to prevent disease flare and tumor recurrence.
Keywords: EGFR ex20ins, sunvozertinib, neoadjuvant therapy, downstaging, disease flare