# Tumor Cavitation with Anlotinib Treatment in Lung Adenocarcinoma

## TL;DR

A patient with lung cancer showed tumor cavitation after treatment with anlotinib and a TKI, but the response was temporary.

## Contribution

Demonstrates tumor cavitation as a potential radiographic marker of anti-angiogenic therapy efficacy in EGFR-mutated lung adenocarcinoma.

## Key findings

- The patient exhibited near-complete cavitation of lung nodules after treatment with aumolertinib and anlotinib.
- Disease progression occurred two months later with new liver metastases.
- Tumor cavitation may indicate anti-angiogenic activity but does not prevent metastatic spread.

## Abstract

Tumor cavitation is distinguished by the emergence of central necrosis and cavity formation within the tumor mass, which indicates a notable outcome of anti-angiogenic therapies. This case describes a 52-year-old Chinese female with advanced EGFR-mutated lung adenocarcinoma (Exon 19 deletion), which was metastatic to bilateral lungs, brain, and right adrenal gland, who exhibited a radiographic response to combination therapy with the third-generation EGFR tyrosine kinase inhibitor (TKI) aumolertinib and the anti-angiogenic agent anlotinib. The patient achieved near-complete cavitation of almost all bilateral lung nodules, manifesting as distinctive “bullet hole” lesions on the chest CT. Despite this initial response, disease progression occurred two months later with new liver metastases, culminating in the patient’s death. This case underscores the potential efficacy of EGFR TKIs and anti-angiogenic agents in inducing unique tumor microenvironment modifications, while highlighting the transient nature of such responses and the critical need to address resistance mechanisms. Tumor cavitation may serve as a radiographic marker of anti-angiogenic activity but does not preclude metastatic spread, necessitating vigilant monitoring even in the setting of favorable imaging changes.