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


METHODS
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.


METHODS
Erlotinib-refractory stage IV lung adenocarcinoma and end-stage symptomatic leptomeningeal metastases with a novel double L858R + E884K somatic mutation of the EGFR.


RESULTS
Carboplatin, paclitaxel and erlotinib, whole-brain radiotherapy, temozolomide with and without irinotecan, and gefitinib.
Choong
Nicholas W
NW
Section of Hematology-Oncology, University of Chicago, Chicago, IL, USA.
Dietrich
Sascha
S
Seiwert
Tanguy Y
TY
Tretiakova
Maria S
MS
Nallasura
Vidya
V
Davies
Gareth C
GC
Lipkowitz
Stanley
S
Husain
Aliya N
AN
Salgia
Ravi
R
Ma
Patrick C
PC
D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology*; D000368:Aged; D001859:Bone Neoplasms / Q000556:secondary*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000473:pathology*; D066246:ErbB Receptors / Q000187:drug effects / Q000235:genetics*; D000069347:Erlotinib Hydrochloride; D005260:Female; D000077156:Gefitinib; D006801:Humans; D008577:Meningeal Neoplasms / Q000556:secondary*; D009154:Mutation; D011799:Quinazolines / Q000627:therapeutic use*; D012272:Ribs / Q000473:pathology*; D017211:Treatment Failure
D011799:Quinazolines; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors; D000077156:Gefitinib