【摘要】 表皮生长因子受体（epidermal growth factor receptor,EGFR）突变中最常见的突变是外显子19缺失突变和外显子21 L858R突变，这两种突变都对EGFR酪氨酸激酶抑制剂（EGFR-tyrosine kinase inhibitors,EGFR-TKIs）有非常好的响应性。然而，EGFR-TKIs对罕见EGFR突变的疗效尚有争议。在治疗过程中，许多患者最终也会对EGFR-TKIs产生耐药性。此外，对于对奥希替尼产生耐药性的患者，特别是那些具有罕见或复杂突变的患者，仍然没有标准的治疗方案。本文介绍了1例具有EGFR L747S和L858R双突变的肺腺癌患者，该患者在出现奥希替尼耐药后接受帕博利珠单抗联合化疗治疗有效，且无疾病进展生存期为13个月。这是国内外首例在携带EGFR L747S和L858R双突变的肺腺癌患者对奥希替尼耐药之后使用帕博利珠单抗免疫治疗联合化疗的报道，本案例可为具有类似罕见突变患者的治疗提供参考。更多还原

【Abstract】 Exon 19 deletion mutation and exon 21 L858R mutation are the most prevalent epidermal growth factor receptor(EGFR) mutations that are responsive to EGFR tyrosine kinase inhibitors(EGFR-TKIs). However, the efficacy of EGFR-TKIs against rare EGFR mutations is debatable. Many patients will eventually develop resistance to EGFR-TKIs over time.Furthermore, there is still no standard protocol for patients developing resistance to Osimertinib,particularly those with rare or complex mutations. Here, we present a lung adenocarcinoma patient with EGFR L747S and L858R double mutations, who responded to Pembrolizumab plus chemotherapy after developing Osimertinib resistance, with a thirteen-month response duration.This is the first report of the efficacy of Pembrolizumab plus chemotherapy after Osimertinib resistance on a patient harboring EGFR L747S and L858R double mutations. Our case can serve as a therapy recommendation for patients with comparable rare mutations.更多还原