title: Complete metabolic remission with Gefitinib in a hemodialysis patient with bone metastases from non-small cell lung cancer.
abstract: Gefitinib is highly active in patients with advanced or metastatic non-small cell lung cancer (NSCLC) harboring activating mutation of the epidermal growth factor receptor (EGFR) gene. The feasibility and the degree of response to treatment with gefitinib in patients with chronic renal failure (CRF) undergoing hemodialysis has not yet been fully described in literature. We describe the case of a 70-year-old man with CRF undergoing hemodialysis three times-a-week who developed vertebral and rib bone metastasis three years after lobectomy. The bone biopsy confirmed the pulmonary origin and pyrosequencing analysis revealed deletion in E746-E750 of exon 19. We started daily administration of 250 mg gefitinib with no changes in the hemodialysis schedule. Gefitinib was well-tolerated without any adverse event. After three months, the (18)F-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG PET/CT) showed complete metabolic remission of bone lesions. The patient is still under treatment and maintains response (30 months to date). To our knowledge, this is the first description of complete metabolic remission in this type of patient. In conclusion, gefitinib has been safely administered to a patient with NSCLC with EGFR-activating mutation undergoing chronic hemodialysis and its use has achieved an excellent and prolonged response on bone metastases.
authors.affiliation: Medical Oncology, S. Maria degli Angeli Hospital, via Montereale 24, 33170 Pordenone, Italy. alessandro.delconte@aopn.fvg.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Del Conte
authors.forename: Emilio
authors.initials: E
authors.lastname: Minatel
authors.forename: Domenico
authors.initials: D
authors.lastname: Schinella
authors.forename: Tanja
authors.initials: T
authors.lastname: Baresic
authors.forename: Stefano M M
authors.initials: SM
authors.lastname: Basso
authors.forename: Franco
authors.initials: F
authors.lastname: Lumachi
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000209:etiology / Q000556:secondary; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D005240:Feasibility Studies; D000077156:Gefitinib; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D008297:Male; D049268:Positron-Emission Tomography; D011379:Prognosis; D011799:Quinazolines / Q000627:therapeutic use*; D012074:Remission Induction; D006435:Renal Dialysis / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D000077156:Gefitinib
keywords: Lung cancer; NSCLC; bone metastasis; gefitinig; hemodialysis