RESUMO
OBJECTIVE: To study the clinical efficacy of acetylcysteine combined with pirfenidone in patients with pulmonary fibrosis (PF). METHODS: A total of 114 PF patients admitted from January 2018 to January 2019 were retrospectively analyzed. Among them, 64 patients treated with acetylcysteine combined with pirfenidone were classified into a research group, and the other 50 treated with acetylcysteine combined with budesonide were assigned into a control group. The clinical efficacy and total effectiveness rate of the two groups were compared after 6 months of therapy. The quality of life (QoL) in the two groups before and after treatment was evaluatedusing Asthma Therapy Assessment Questionnaire for idiopathic pulmonary fibrosis patients (ATAQ-IPF). The 2-year survival of the two groups was compared. Additionally, the incidence of adverse reactions was compared between the two groups. The changes in forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), inflammatory factors, and PF markers were compared between the two groups before and after therapy. RESULTS: There were no significant differences in clinical efficacy or total effectiveness rate (all P > 0.05), serum IL-4, INFγ or IL-6 expression (all P > 0.05), as well as FEV1 and FVC levels (all P > 0.05) after therapy between two groups. After therapy, the research group showed significantly lower PCIII and HA levels, lower ATAQ-IPF scores, and lower total incidence of adverse reactions than the control group (all P < 0.05). In addition, a higher 2-year survival rate was observed in the research group than in the control group (P=0.025). CONCLUSION: Acetylcysteine combined with pirfenidone can reduce adverse reactions and improve the QoL and survival time of patients.
RESUMO
Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (EGFR-TKIs) have become the first choice for patients with sensitive mutations and have significantly improved prognosis. EGFR exon 19 deletions and L858R mutation in exon 21 are the most common sensitive mutations in lung adenocarcinoma. With advances in detection technology, some rare variants of EGFR have been detected, including EGFR kinase domain duplications and EGFR fusions. Only a few reports have revealed the effectiveness of EGFR-TKIs in patients with these rare variants. In this study, we report a case of EGFR-RAD51 fusion in lung adenocarcinoma that showed a response to icotinib; these findings provide additional support for the use of EGFR-TKIs for patients with these atypical variants. KEY POINTS: A young patient with lung adenocarcinoma harboring a rare EGFR-RAD51 fusion who responded to icotinib with a PFS of longer than 15 months.All reported EGFR-RAD51 fusions have the same breakpoints and show responses to EGFR-TKIs including icotinib, except for one patient who responded to chemotherapy.Although EGFR fusion is a rare EGFR variant type, the efficacy of EGFR-TKIs suggests the necessity for new detection technology, such as NGS, for patients with lung adenocarcinoma.The clinical usage of NGS could maximize the benefits of precision medicine in patients with cancer.The current case provides new evidence for the efficacy of icotinib in patients with the rare EGFR-RAD51 fusion and EGFR-activating mutations.
