Gefitinib response of erlotinib-refractory lung cancer involving meninges - Role of EGFR mutation

Nicholas W. Choong, Sascha Dietrich, Tanguy Y. Seiwert, Maria S. Tretiakova, Vidya Nallasura, Gareth C. Davies, Stanley Lipkowitz, Aliya N. Husain, Ravi Salgia, Patrick Chi-Chung Ma

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104 Scopus citations

Abstract

Background: A 70-year-old Japanese -American woman who had never smoked was diagnosed with stage IV non-small-cell lung cancer with rib metastases. She had previously been well and she had no family history of malignancy. While receiving treatment with erlotinib, an epidermal growth factor receptor small-molecule inhibitor, she progressed and developed new brain metastases. She failed further chemotherapy treatments and subsequently developed extensive symptomatic leptomeningeal carcinomatosis associated with diplopia, hemiparesis, weight loss, and incontinence. Investigations: Chest X-ray, head and chest CT scan, R2 lymph-node biopsy, histopathology, immunohistochemistry, MRI of head and spine, lumbar puncture, laser microdissection and EGFR genomic DNA sequencing of the R2 lymph node and cerebrospinal fluid tumor cells. Diagnosis: Erlotinib-refractory stage IV lung adenocarcinoma and end-stage symptomatic leptomeningeal metastases with a novel double L858R + E884K somatic mutation of the EGFR. Management: Carboplatin, paclitaxel and erlotinib, whole-brain radiotherapy, temozolomide with and without irinotecan, and gefitinib.

Original languageEnglish (US)
Pages (from-to)50-57
Number of pages8
JournalNature Clinical Practice Oncology
Volume3
Issue number1
DOIs
StatePublished - Jan 1 2006

All Science Journal Classification (ASJC) codes

  • Oncology

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    Choong, N. W., Dietrich, S., Seiwert, T. Y., Tretiakova, M. S., Nallasura, V., Davies, G. C., Lipkowitz, S., Husain, A. N., Salgia, R., & Ma, P. C-C. (2006). Gefitinib response of erlotinib-refractory lung cancer involving meninges - Role of EGFR mutation. Nature Clinical Practice Oncology, 3(1), 50-57. https://doi.org/10.1038/ncponc0400