Abstract | BACKGROUND: CASE PRESENTATION: A 67 year old man with metastatic gallbladder cancer involving the liver and abdominal lymph nodes was treated with gemcitabine (1000 mg/m2) on day 1 and 8 every 21 days as well as daily erlotinib (100 mg). After four cycles of therapy, the CA 19-9 normalized and a PET/CT showed a complete remission; this response was maintained by the end of 12 cycles of therapy. Gemcitabine was then discontinued and single agent erlotinib was continued as maintenance therapy. The disease remains in good control 18 months after initiation of therapy, including 6 months on maintenance erlotinib. The only grade 3 toxicity was a typical EGFR-related skin rash. Because of the remarkable response to erlotinib plus gemcitabine, we performed tumor genotyping of the EGFR gene for response predicting mutations in exons 18, 19 and 21. This disclosed the wild-type genotype with no mutations found. CONCLUSION: This case report demonstrates a patient with stage IV gallbladder cancer who experienced a rarely encountered complete, prolonged response after treatment with an oral EGFR-TKI plus chemotherapy. This response occurred in the absence of an EGFR gene mutation. These observations should inform the design of clinical trials using EGFR-TKIs to treat gallbladder and other biliary tract cancers; such trials should not select patients based on EGFR mutation status.
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Authors | Kabir Mody, Edward Strauss, Robert Lincer, Richard C Frank |
Journal | BMC cancer
(BMC Cancer)
Vol. 10
Pg. 570
(Oct 20 2010)
ISSN: 1471-2407 [Electronic] England |
PMID | 20961434
(Publication Type: Case Reports, Journal Article)
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Chemical References |
- Antimetabolites, Antineoplastic
- CA-19-9 Antigen
- Quinazolines
- Deoxycytidine
- Erlotinib Hydrochloride
- ErbB Receptors
- Gemcitabine
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Topics |
- Aged
- Antimetabolites, Antineoplastic
(therapeutic use)
- CA-19-9 Antigen
(biosynthesis)
- DNA Mutational Analysis
- Deoxycytidine
(administration & dosage, analogs & derivatives)
- ErbB Receptors
(genetics)
- Erlotinib Hydrochloride
- Exons
- Gallbladder Neoplasms
(drug therapy, genetics)
- Humans
- Lymphatic Metastasis
- Male
- Mutation
- Positron-Emission Tomography
(methods)
- Quinazolines
(administration & dosage)
- Treatment Outcome
- Gemcitabine
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