Sequential tyrosine kinase inhibitor therapy for EGFR L747P-mutated lung adenocarcinoma in a renal transplant recipient: a 24-month case report.

Background: Kidney transplant recipients (KTRs) are at increased risk of malignancies, including lung adenocarcinoma (LUAD). The therapeutic efficacy of tyrosine kinase inhibitors (TKIs) against the rare EGFR L747P mutation remains controversial. Case presentation: We report a 60-years-old female renal transplant recipient who developed advanced lung adenocarcinoma harboring the EGFR L747P mutation. Management and outcomes: The patient was treated sequentially with three generations of EGFR TKIs-gefitinib, osimertinib, and dacomitinib-while continuing immunosuppressive therapy for graft function. Gefitinib achieved a progression-free survival (PFS) of 9 months, osimertinib 4.5 months, and dacomitinib 2.5 months, resulting in a total overall survival (OS) of 24 months. Treatment was generally well tolerated, with only mild adverse events and manageable renal function changes. Conclusion: To our knowledge, this is the first reported case of an EGFR L747P-mutated lung adenocarcinoma in a renal transplant recipient benefiting from sequential multi-TKI therapy. This case underscores the importance of vigilant cancer surveillance in transplant recipients and suggests that individualized TKI sequencing may offer clinical benefit, although further evidence is required.