Authors: Check DL, Check JH, Poretta T, Aikins J, Wilson C.
Though representing only a minority of cases of non-small cell lung cancer (NSCLC), the presence of the epidermal growth factor receptor (EGFR) mutation is associated with a better prognosis than other types of lung cancer, because the tumor responds well to targeted therapy especially with third generation tyrosine kinase inhibitors (TKI). The objective of the present case study was to determine if the use of the progesterone modulator mifepristone could extend a high quality of life, by targeting the progesterone induced blocking factor (PIBF), that seems to be present in most malignant tumors, especially when they are advanced. Two such patients, no longer responding to the third generation TKI osimertinib, were treated with 200mg oral mifepristone while remaining on osimertinib. These patients have enjoyed a high quality of life and are ECOG-zero, after approximately 1 1⁄2 and 2 years of mifepristone therapy. Based on other experiences using single agent mifepristone, the patients are probably responding to single agent mifepristone, without much contribution from the osimertinib. Nevertheless, since the two drugs were well tolerated together, one may consider starting both drugs simultaneously when there is advanced NSCLC with the EGFR mutation. Mifepristone has demonstrated in previous reports increased quality and length of life in patients with advanced chemo-resistant NSCLC with no tumor markers, advanced NSCLC positive for programmed death factor-1 and progressing despite nivolumab, advanced small cell lung cancer, and now NSCLC with the EGFR mutation progressing despite the third generation TKI osimertinib.
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