Gefitinib
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Worsening of carcinomatous meningitis in an elderly patient: case report A 69-year-old man experienced worsening of carcinomatous meningitis while receiving gefitinib. The man had been diagnosed with metastatic lung adenocarcinoma. Following surgery and chemotherapy he began to experience headaches and was diagnosed with carcinomatous meningitis. He started receiving gefitinib [dosage and route not stated]. Initially his headaches and other symptoms improved, but 2 months after starting gefitinib his blood CEA level increased. Four months after starting the drug his headaches returned, and he began to experience disorientation. He was admitted to hospital. Examination found that he had developed a rash, attributed to gefitinib, and he showed impaired temporal and spatial orientation. His blood CEA level was 198.3 ng/mL. A diagnosis of carcinomatous meningitis was confirmed and gefitinib was discontinued. The man started receiving erlotinib; his headaches resolved and his disorientation improved, disappearing after a month. His blood CEA level declined and he was discharged from hospital on day 33 of his treatment. He developed nail loss and grade 1 rash, both attributed to erlotinib. He developed headaches 8 months after starting erlotinib, and the drug was discontinued. Disease progression was noted, and he started receiving chemotherapy but this was discontinued as his condition worsened. Despite restarting erlotinib, he continued to decline, and died 4 months after restarting the drug. Author comment: We report on our experience of a case of lung adenocarcinoma in which administration of gefitinib was initially effective for EGFR gene mutation-positive carcinomatous meningitis, but in which, when the carcinomatous meningitis alone then worsened further, we found that changing to erlotinib produced an improvement. Watanabe Y, et al. A case of lung adenocarcinoma which developed carcinomatous meningitis during gefitinib treatment, improving after switching to erlotinib. Haigan / Japanese Journal of Lung Cancer 53: 114-120, No. 2, Jan 2013. Available from: URL: http://dx.doi.org/10.2482/haigan.53.114 [Japanese; summarised from a 803096207 translation] - Japan
0114-9954/13/1480-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved
Reactions 30 Nov 2013 No. 1480
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