Successful neoadjuvant treatment of EGFR exon 19 deletion combined with TP53 mutation in non-small cell lung cancer using aumolertinib after osimertinib-induced myocardial damage - a case report and literature review

Sep 24, 2026

Neoadjuvant therapy for stage IIIA lung adenocarcinoma is retrospectively analyzed in a case report following osimertinib-induced myocardial injury. Genetic testing identified EGFR exon 19 deletion with TP53 mutation (mutant abundance 33.5% and 14%). After myocardial damage and cardiopulmonary complications emerged one month into osimertinib therapy, aumolertinib rechallenge was given. Myocardial enzyme abnormalities normalized and bilateral interstitial edema resolved, while lung lesions and mediastinal lymph nodes markedly regressed, enabling successful surgery with no further cardiac adverse reactions.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Introduction

Clinical rationale for EGFR-TKIs and third-generation therapy

Case presentation

Diagnosis and genetic findings

Treatment course and adverse event management

Outcomes and discussion

Tumor response, surgery success, and implications

954 Case report Successful neoadjuvant treatment of EGFR exon 19 deletion combined with TP53 mutation in non-small cell lung cancer using aumolertinib after osimertinib-induced myocardial damage: a case report and literature review Guijuan Zhanga, Xiaoyuan Tanga, Xingping Zhangb, Xingting Qiuc, Qingwen Laia and Jie Lia The development of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) represents a paradigm shift in the treatment of lung cancer with EGFR mutations. Aumolertinib has been shown to bea safe agent in the registry study. However, successful rechallenge with aumolertinib following osimertinibinduced myocardial damage has not been reported. In this article, a case of neoadjuvant therapy for lung adenocarcinoma is retrospectively analyzed, and the relevant literature is reviewed. The patient was diagnosed with stage IIIA lung adenocarcinoma, and genetic testing revealed EGFR exon 19 deletion mutation combined with Tumor Protein p53 (TP53) mutation. The mutation abundance is 33.5 and 14%, respectively. One month after osimertinib treatment, the patient developed myocardial damage, and abnormal indicators such as myocardial enzyme spectrum showed abnormalities and cardiac insufficiency, followed by pulmonary hypertension and pulmonary edema. Aumolertinib was subsequently used for treatment, following which the myocardial enzyme spectrum returned to normal, and the symptoms of bilateral interstitial edema disappeared. In addition to the disappearance of adverse reactions, the therapeutic effect was excellent; the lung lesions and mediastinal lymph nodes were significantly reduced, and the operation was successfully conducted. This is the first report of successful neoadjuvant treatment of EGFR exon 19 deletion combined with TP53 mutation in NSCLC using aumolertinib after osimertinib-induced myocardial damage. The results suggested that aumolertinib had fewer adverse reactions in patients with EGFR exon 19 deletion combined with TP53 mutation, and aumolertinib may be a potential neoadjuvant therapy for stage IIIA lung cancer. Anti-Cancer Drugs 34: 954–961 Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. Anti-Cancer Drugs 2023, 34:954–961 Keywords: aumolertinib, case report, epidermal growth factor receptor, osimertinib aDepartment of Respiratory and Critical Care, First Affiliated Hospital of Gannan Medical University, bCyberspace Institute of Advanced Technology, Guangzhou University and cDepartment of Radiology, First Affiliated Hospital of Gannan Medical University, Ganzhou, China Correspondence to Jie Li, MM, First Affiliated Hospital of Gannan Medical University, Ganzhou, China Received 25 November 2022 Revised form accepted 25 November 2022. Introduction Lung cancer is one of the most serious malignant tumors in the world. GLOBOCAN estimates that in 2020, there will be approximately 2.2 million new cases of lung cancer worldwide, accounting for 11.4% of all malignancies, and approximately 1.8 million deaths, accounting for 18.0% of malignant tumor-related deaths [1]. Nonsmall cell lung cancer (NSCLC) is the most common type of lung cancer, accounting for approximately 85% of all lung cancers, with a 5-year survival rate of less than 15% [2,3]. Patients with advanced NSCLC with epidermal growth factor receptor (EGFR) mutation form a special group, which is sensitive to tyrosine kinase inhibitors (TKIs) of EGFR and shows significantly improved This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBYNC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. progression-free survival and objective response rate [4]. Several clinical studies have confirmed that first-generation EGFR-TKIs (gefitinib [5], erlotinib [6], and icotinib

FAQs

What genetic alterations were found in the patient?

Testing revealed an EGFR exon 19 deletion mutation combined with a TP53 mutation, with mutant abundances of 33.5% and 14% respectively.

What complication occurred after osimertinib treatment?

One month after osimertinib, the patient developed myocardial damage and subsequent cardiopulmonary complications, including abnormalities on myocardial enzyme testing and cardiac insufficiency, followed by pulmonary hypertension and pulmonary edema.

How did the patient respond after switching to aumolertinib?

After starting aumolertinib, myocardial enzyme spectrum returned to normal and symptoms of bilateral interstitial edema disappeared; lung lesions and mediastinal lymph nodes significantly reduced, allowing successful surgery.

Sep 24, 2026

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