First-line osimertinib for leptomeningeal metastasis from lung adenocarcinoma with EGFR mutation as the initial and soli
- PDF / 1,268,450 Bytes
- 5 Pages / 595.276 x 790.866 pts Page_size
- 9 Downloads / 183 Views
CASE REPORT
First‑line osimertinib for leptomeningeal metastasis from lung adenocarcinoma with EGFR mutation as the initial and solitary site of postoperative recurrence Yuki Ono1 · Kazuki Takada1 · Atsushi Osoegawa1 · Fumihiko Kinoshita1 · Taro Oba1 · Shuichi Tsukamoto3 · Tetsuzo Tagawa1 · Yoshinao Oda2 · Masaki Mori1 Received: 5 July 2020 / Accepted: 4 October 2020 © The Japan Society of Clinical Oncology 2020
Abstract Leptomeningeal metastasis (LM) from lung cancer has poor prognosis, and effective therapy has not been established. We present the case of a 54-year-old man with LM from lung adenocarcinoma harboring EGFR L858R point mutation, who received osimertinib as first-line therapy. He had previously undergone left lower lobectomy and lymph node dissection for lung adenocarcinoma. Five years and 9 months after the operation, he developed symptoms of dizziness, lightheadedness, and headache. Magnetic resonance imaging showed high signal intensity in the cerebral sulcus and meninges, and cerebrospinal fluid (CSF) cytology indicated adenocarcinoma with EGFR L858R point mutation, which suggested LM. After CSF drainage and administration of corticosteroid and glycerol, the patient received osimertinib (80 mg/day) as first-line therapy. These symptoms including dizziness, lightheadedness, and headache were relieved and the MRI appearance was normal, and he survived for 19 months with no disease progression. Osimertinib is considered to be an effective therapeutic option for LM from lung adenocarcinoma harboring EGFR mutation. Keywords Lung adenocarcinoma · Leptomeningeal metastasis · EGFR mutation · Osimertinib
Introduction EGFR mutation is one of the major driver mutations in lung adenocarcinoma and is known to be a therapeutic target. However, therapy has not been established for leptomeningeal metastasis (LM) from lung adenocarcinoma with EGFR mutation. To date, the first-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) gefitinib and erlotinib have been effective for LM with EGFR mutation [1, 2]. The third-generation EGFR-TKI osimertinib has been effective as second-line therapy for LM with EGFR * Tetsuzo Tagawa [email protected]‑u.ac.jp 1
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3‑1‑1 Maidashi, Higashi‑ku, Fukuoka 812‑8582, Japan
2
Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
3
Department of Thoracic Surgery, Steel Memorial Yawata Hospital, Kitakyushu, Japan
T790M mutation [3]. We present a case of LM from lung adenocarcinoma harboring EGFR mutation that received osimertinib as first-line therapy.
Case A 54-year-old man with a history of smoking was referred to our hospital for X-ray examination of a thoracic mass (Fig. 1a). Computed tomography (CT) scan showed a 10-mm nodule in the left lower lung lobe (Fig. 1b), and positron emission tomography—CT scan demonstrated high accumulation of fluorodeoxyglucose, with maximum standardized upta
Data Loading...
