title: Carcinomatous meningitis from non-small-cell lung cancer responding to gefitinib.
abstract: The prognosis for carcinomatous meningitis remains poor, and focal neurological dysfunctions usually do not improve despite the available treatment options. We report a case of carcinomatous meningitis from non-small-cell lung cancer treated with gefitinib, which brought about a sustained clinical response. A 40-year-old Japanese man was diagnosed with adenocarcinoma in the right lower lobe of the lung, and with multiple pulmonary and brain metastases. Six courses of carboplatin and paclitaxel chemotherapy and gamma-knife radiosurgery induced a near complete response in all lesions. However, 2 months later, cauda equina syndrome and left oculomotor paralysis from carcinomatous meningitis developed rapidly. Magnetic resonance imaging of the brain and spinal cord revealed the enhancement of leptomeningeal disseminations. The patient was treated with 250 mg/day gefitinib. All his neurological symptomatology disappeared within 2 weeks. The shrinkage of the leptomeningeal disseminations was confirmed by follow-up magnetic resonance imaging. The patient is currently doing well and is able to work. Cancer relapse was not observed at 4 months after the initiation of gefitinib. Although the survival benefit is controversial, gefitinib may have a role in the treatment of carcinomatous meningitis from non-small-cell lung cancer to improve neurological dysfunctions.
authors.affiliation: Department of Surgery, Institute of Clinical Medicine, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan. misakai@md.tsukuba.ac.jp
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Sakai
authors.forename: Shigemi
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Ito
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Ozawa
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Masataka
authors.initials: M
authors.lastname: Onizuka
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Sakakibara
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000556:secondary*; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008577:Meningeal Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D008581:Meningitis / Q000188:drug therapy / Q000209:etiology; D011799:Quinazolines / Q000627:therapeutic use*
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D000077156:Gefitinib