Integrated Traditional Chinese and Western Medicine in Lung Adenocarcinoma with Rare EGFR Mutation and Nephrotic Syndrome: A Case Report

This case report presents a 67-year-old male diagnosed with stage IV lung adenocarcinoma harboring rare EGFR exon 18/20 mutations (Gly719Cys/Ser768Ile) and a concurrent TP53 mutation, complicated by nephrotic syndrome. The scarcity of approved EGFR-TKIs targeting rare EGFR mutations in NSCLC, coupled with nephrotic syndrome-induced renal impairment, hypoalbuminemia, and massive pleural effusion refractory to conventional management, prompted the development of a personalized multimodal approach.A multimodal therapeutic regimen incorporating albumin-bound paclitaxel, intrathoracic perfusion of Endostar (recombinant human endostatin), and traditional Chinese medicine (TCM) was implemented, achieving effective disease control. Notably, the treatment resulted in significant tumor shrinkage (reduction rate: 48.1% by RECIST 1.1), complete resolution of malignant pleural effusion, and marked improvement in nephrotic syndrome parameters. The synergistic effects of targeted chemotherapy, anti-angiogenic therapy, and TCM-based symptom modulation highlight the potential of integrative approaches in managing advanced malignancies with complex molecular profiles and multisystem complications.