Supplementary Material for: Metachronous Presentation of BCL2-Positive Lung Adenocarcinoma and Acute Myeloid Leukemia: a case presentation and review of the literature

Introduction: Managing metachronous primary malignancies (MPMs) such as EGFR-mutant lung adenocarcinoma and acute myeloid leukemia (AML) presents significant clinical challenges. This case report illustrates the therapeutic strategies employed to address shared molecular markers and the application of personalized medicine techniques for refractory disease in a patient with both malignancies.
Case Presentation: A female patient in her late 40s, diagnosed with Stage IVB EGFR L858R lung adenocarcinoma (high BCL-2 expression), was treated with radiotherapy and icotinib. Seven months after initiating lung cancer therapy, she developed AML with t(8;21). Initial AML treatment with Venetoclax plus azacitidine, targeting BCL-2 positivity, achieved complete remission (CR). However, relapse occurred several months later. Due to ineligibility for hematopoietic stem cell transplantation (HSCT), a rapid in vivo MiniPDX drug sensitivity assay using the patient’s leukemia cells guided the selection of salvage therapy with Selinexor, Decitabine, and Venetoclax. This regimen successfully induced a second CR in the refractory AML. At the time of reporting, the patient continues treatment for both active malignancies.
Conclusion: This case underscores the complexity of managing distinct MPMs and the potential for dual-targeting strategies, such as leveraging BCL-2 expression with Venetoclax for both malignancies. The MiniPDX assay proved invaluable in guiding personalized therapy for refractory AML within this challenging MPM context, highlighting the need for further research into such innovative approaches.