Intracranial complete remissions in an aumolertinib-treated EGFR mutation-positive non-small cell lung cancer (NSCLC) patient with symptomatic brain metastases and Eastern Cooperative Oncology Group performance status (ECOG PS) up to 4: a case report

BACKGROUND: Brain metastases happen in approximately 70% of epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC) patients. It negatively impacts the survival and quality of life, with the median survival time for untreated patients is just 2.9 months. Nevertheless, no extensive research data is available for symptomatic brain metastases because asymptomatic brain metastases patients are usually included in the clinical trials then. CASE DESCRIPTION: Here, we report a 74-year-old male lung cancer patient with symptomatic brain metastases and performance status (PS) score of ~4. The patient was presented to our clinic on July 19 2020 with dizziness for one day, convulsions in the right lower limb for 2 hours, nausea, and severe vomiting. Further tissue and imaging analysis revealed EGFR-mutant stage IV (cT2N3M1) NSCLC with multiple brain metastases and cerebral edema. Initially, he was treated with bevacizumab on July 24(th) for one cycle, then with novel third-generation EGFR-tyrosine kinase inhibitor (TKI) aumolertinib at 110 mg daily from July 31(st) until disease control. Systemic partial remission (PR) and complete intracranial remission had been achieved in the lung and intracranial lesions. Notably, the PS score has detected as a level 4 at the time of diagnosis. After 2 weeks of aumolertinib administration, the patient showed significant improvement, and the PS score returned to 0. Interestingly, the patient significantly recovered from brain metastases and living a healthy daily life; nevertheless, he is currently receiving aumolertinib monotherapy for NSCLC and being follow-up for clinical updates. CONCLUSIONS: Our case presented a patient with EGFR-mutant NSCLC with symptomatic brain metastases. Aumolertinib proved to be a highly effective and well-tolerated treatment option for sustained disease control and comprehensive future studies are needed to confirm its efficacy in a larger population.