Successful EGFR-TKI rechallenge of leptomeningeal carcinomatosis after gefitinib-induced interstitial lung disease.

Abstract

We report the case of a 49-year-old non-smoking Japanese woman with backache and difficulty in walking. She was diagnosed as having advanced lung adenocarcinoma, and an epithelial growth factor receptor mutation (in-frame deletions in exon 19) was found. After radiation therapy of bone metastases with spinal cord compression and brain metastases, gefitinib was administered. On day 2, she developed acute interstitial lung disease. Gefitinib therapy was discontinued and treatment with high-dose steroid therapy improved the interstitial lung disease. Cisplatin plus pemetrexed was initiated as second-line chemotherapy, but she was hospitalized again for leptomeningeal carcinomatosis. Considering the poor prognosis of leptomeningeal carcinomatosis, we decided that erlotinib was our only choice of treatment. As a third-line treatment, erlotinib was administered after informing the patient about the high risk of interstitial lung disease. Neurological symptoms were improved within a week and interstitial lung disease did not recur. The patient has received erlotinib successfully for 18 months without the recurrence of leptomeningeal carcinomatosis. Erlotinib rechallenge after gefitinib-induced interstitial lung disease must be carefully chosen based on the balance of a patient's risk and benefit.

• Authors: Shinji Nakamichi, Kaoru Kubota, Hidehito Horinouchi, Shintaro Kanda, Yutaka Fujiwara, Hiroshi Nokihara, Noboru Yamamoto, Tomohide Tamura
• Journal: Japanese journal of clinical oncology (Jpn J Clin Oncol) Vol. 43 Issue 4 Pg. 422-5 (Apr 2013) ISSN: 1465-3621 [Electronic] England
• PMID: 23410901 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antineoplastic Agents
• Protein Kinase Inhibitors
• Quinazolines
• Erlotinib Hydrochloride
• ErbB Receptors
• Gefitinib

Topics

• Adenocarcinoma (pathology)
• Antineoplastic Agents (adverse effects)
• ErbB Receptors (metabolism)
• Erlotinib Hydrochloride
• Female
• Gefitinib
• Humans
• Lung Diseases, Interstitial (chemically induced)
• Lung Neoplasms (pathology)
• Meningeal Carcinomatosis (drug therapy, secondary)
• Middle Aged
• Protein Kinase Inhibitors (therapeutic use)
• Quinazolines (adverse effects, therapeutic use)