title: Clinical Efficacy of Afatinib Treatment for a Patient with Leptomeningeal Carcinomatosis.
abstract: Leptomeningeal metastases occur in 1% of patients with non-small-cell lung cancer. There have been several reports on the treatment of leptomeningeal metastases with afatinib. Our patient was a 41-year-old woman who had never smoked and was diagnosed with stage IV adenocarcinoma of the lung with an epidermal growth factor receptor (EGFR) mutation. She was treated with afatinib for the recurrence of leptomeningeal metastases. After the treatment with afatinib was initiated, the neurological symptoms dramatically regressed, and she achieved progression-free survival for 7 months. The concentration of afatinib in the cerebrospinal fluid (CSF) ranged from 0.05 to 0.14 ng/mL, and the penetration rate of afatinib from the plasma to the CSF ranged from 0.28 to 0.40%. This concentration might be sufficient to achieve a clinical effect for leptomeningeal carcinomatosis. Therefore, afatinib administered at the usual doses may be an effective treatment for leptomeningeal carcinomatosis of EGFR-mutated or EGFR-tyrosine kinase inhibitor-sensitive lung adenocarcinoma.
authors.affiliation: Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu City, Japan.
authors.forename: Yo
authors.initials: Y
authors.lastname: Kawaguchi
authors.forename: Jun
authors.initials: J
authors.lastname: Hanaoka
authors.forename: Hideki
authors.initials: H
authors.lastname: Hayashi
authors.forename: Naoki
authors.initials: N
authors.lastname: Mizusaki
authors.forename: Hirotoshi
authors.initials: H
authors.lastname: Iihara
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Itoh
authors.forename: Tadashi
authors.initials: T
authors.lastname: Sugiyama
mesh_terms: D000328:Adult; D000077716:Afatinib; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000188:drug therapy; D018572:Disease-Free Survival; D066246:ErbB Receptors / Q000235:genetics; D005260:Female; D000077156:Gefitinib; D006801:Humans; D008279:Magnetic Resonance Imaging; D055756:Meningeal Carcinomatosis / Q000150:complications / Q000188:drug therapy*; D009154:Mutation; D009364:Neoplasm Recurrence, Local; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011799:Quinazolines / Q000008:administration & dosage / Q000097:blood / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D011838:Radiation-Sensitizing Agents; D000077716:Afatinib; D016190:Carboplatin; D066246:ErbB Receptors; D000077156:Gefitinib