title: Two cases of leptomeningeal metastases from lung adenocarcinoma which progressed during gefitinib therapy but responded to erlotinib.
abstract: We present two patients with leptomeningeal metastases (LM) from lung adenocarcinoma that progressed or newly developed, respectively, during gefitinib therapy which had exhibited substantial antitumor effects on widespread lesions. In both cases, a switch to erlotinib therapy brought about long-lasting dramatic symptomatic improvement and markedly prolonged survival. The first patient is a 46-year-old female who presented with progressive headache and vomiting. Multiple pulmonary, hepatic and bone metastases immediately shrank in response to gefitinib. However, 1 month after completion of concurrent whole brain radiation, dizziness and urinary retention newly emerged, worsening the symptoms observed at presentation. Magnetic resonance imaging (MRI) demonstrated enlargement of ventricles and new gadolinium (Gd)-enhanced disseminated nodules on the surface of the cerebral cortex, suggesting the existence of uncontrollable LM. Sequential erlotinib therapy resulted in symptomatic improvement with a finding of regression of Gd-enhancement on MRI. The beneficial effect lasted for 10 months, though a follow-up brain MRI showed further enlarged ventricles. She finally died due to LM after surviving for 11 months under erlotinib treatment. The other patient is a 55-year-old female in whom headache and vomiting occurred while gefitinib therapy had maintained shrinkage of all pre-existing tumors in the thorax and bones. Brain MRI strongly suggested occurrence of LM with a finding of Gd-enhanced sulci. A switch to erlotinib therapy relieved the symptoms with disappearance of Gd-enhancement. However, the symptoms recurred with a finding of further enlargement of ventricles on brain MRI after 11 months. Finally, she died due to LM after surviving for 12 months under erlotinib treatment.
authors: Department of Respiratory Medicine, Allergy and Rheumatic Diseases, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
authors: Satoshi
authors: S
authors: Tetsumoto
authors: Akio
authors: A
authors: Osa
authors: Takashi
authors: T
authors: Kijima
authors: Toshiyuki
authors: T
authors: Minami
authors: Haruhiko
authors: H
authors: Hirata
authors: Ryo
authors: R
authors: Takahashi
authors: Hanako
authors: H
authors: Kuhara
authors: Izumi
authors: I
authors: Nagatomo
authors: Yoshito
authors: Y
authors: Takeda
authors: Hiroshi
authors: H
authors: Kida
authors: Sho
authors: S
authors: Goya
authors: Isao
authors: I
authors: Tachibana
authors: Ichiro
authors: I
authors: Kawase
references: Ann Oncol. 1999 Jul;10(7):753-9
references: 10470420
references: Nat Clin Pract Oncol. 2006 Jan;3(1):50-7; quiz 1 p following 57
references: 16407879
references: J Thorac Oncol. 2010 Jul;5(7):950-5
references: 20479691
references: J Clin Oncol. 2006 Sep 20;24(27):4517-20
references: 16983123
references: Cancer Treat Rev. 1999 Apr;25(2):103-19
references: 10395835
references: Cancer Invest. 2002;20(3):293-302
references: 12025223
references: AJR Am J Roentgenol. 2001 Jun;176(6):1585-8
references: 11373237
references: Oncogene. 2009 Jan 29;28(4):518-33
references: 19015641
references: Cancer Res. 1982 Jun;42(6):2474-9
references: 6280860
references: Clin Lung Cancer. 2004 Sep;6(2):123-8
references: 15476598
references: Lung Cancer. 1998 May;20(2):93-8
references: 9711527
references: Cancer. 2005 Jun 1;103(11):2344-8
references: 15844174
references: Clin Cancer Res. 2007 Mar 1;13(5):1511-5
references: 17332296
references: Clin Lung Cancer. 2005 Sep;7(2):138-40
references: 16179102
references: J Thorac Oncol. 2009 Nov;4(11):1415-9
references: 19692934
references: Lancet Oncol. 2002 Jan;3(1):53-7
references: 11905606
references: Lung Cancer. 2009 Jul;65(1):80-4
references: 19059670