Activity of pemetrexed and high-dose gefitinib in an EGFR-mutated lung adenocarcinoma with brain and leptomeningeal meta
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CASE REPORT
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Activity of pemetrexed and high-dose gefitinib in an EGFR-mutated lung adenocarcinoma with brain and leptomeningeal metastasis after response to gefitinib Ying Yuan1, Chunwen Tan1, Modan Li1, Hong Shen1, Xuefeng Fang1, Yinghong Hu2 and Shenglin Ma3*
Abstract About 20% to 40% of patients with non-small cell lung cancer (NSCLC) will develop brain metastases during the natural course of their disease. The prognosis for such patients is very poor with limited survival. In addition to the standard whole brain radiation therapy (WBRT), some studies have shown that chemotherapy drugs and/or epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI) can improve the outcome of these patients. Here, we report a stage IIIA patient who developed multiple brain metastases one year after operation. Oral gefitinib with concurrent WBRT were given as first-line therapy. Complete response and a 50-month progressionfree survival (PFS) were obtained. Double dosage of gefitinib (500 mg per day) together with pemetrexed were given as the second-line therapy after the patient developed new brain lesions and leptomeningeal metastasis during the maintenance therapy of gefitinib. The PFS for the second-line therapy was six months. In total, the patient obtained an overall survival of 59 months since the first diagnosis of brain metastases. Mutational analysis showed a 15-nucleotide deletion and a missense mutation in exon 19 of the EGFR gene, and a missense mutation at codon 12 of the K-ras gene. These underlying genetic changes might partially explain the long-term survival of this patient after brain metastases when treated with concurrent or sequential therapies of EGFR-TKI, radiotherapy and chemotherapy. Keywords: Non-small cell lung cancer, Pemetrexed, Epidermal growth factor receptor-tyrosine kinase inhibitors, Mutation
Background The reported incidence of brain metastasis (BM) in patients with non-small cell lung cancer (NSCLC) ranges from 20% to 40%. Multiple cerebral lesions are associated with poor prognosis, and median overall survival from the time of diagnosis is about three to six months. Leptomeningeal metastasis (LM) of NSCLC is more fatal than BM, without treatment, median survival ranges from four to six weeks. The optimal treatment for such patients is controversial, and the use of a combination of radiotherapy, chemotherapy and EGFR-TKI remains unclear. The objective of the present case is to investigate * Correspondence: [email protected] 3 Department of Oncology, Hangzhou First People’s Hospital, Hangzhou Cancer Hospital, 261 Huansha Road, Hangzhou 310006, Zhejiang, China Full list of author information is available at the end of the article
the response to gefitinib and pemetrexed in such a patient.
Case presentation In June 2005, a 52-year-old man was admitted to our hospital after the detection of a mass in his right lung in a routine physical examination. He was a non-smoker and did not have any disease-related symptoms, such as cou
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