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Efficacy of multimodal treatment for leptomeningeal metastases in a lung cancer harboring an EGFR mutation

Authors Morichika D, Kubo T, Gotoda H, Tamura T, Ohashi K, Hotta K, Tabata M, Kurozumi K, Tanimoto M, Kiura K

Received 4 September 2015

Accepted for publication 22 January 2016

Published 22 March 2016 Volume 2016:9 Pages 1753—1758

DOI https://doi.org/10.2147/OTT.S95721

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Ram Prasad

Peer reviewer comments 4

Editor who approved publication: Prof. Dr. Giuseppe Tonini


Daisuke Morichika,1 Toshio Kubo,2 Hiroko Gotoda,1 Tomoki Tamura,1 Kadoaki Ohashi,1 Katsuyuki Hotta,1 Masahiro Tabata,2 Kazuhiko Kurozumi,3 Mitsune Tanimoto,4 Katsuyuki Kiura1

1Department of Respiratory Medicine, 2Center for Clinical Oncology, Okayama University Hospital, Okayama, Japan; 3Department of Neurological Surgery, 4Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan

Abstract:
For lung cancer patients with epidermal growth factor receptor (EGFR) mutations, the advent of EGFR tyrosine kinase inhibitors (TKIs) has prolonged survival rates. Even though disease sites have been well controlled by EGFR-TKIs, some patients develop carcinomatous meningitis, which reduces their quality of life drastically. Although multidisciplinary approaches have improved patient survival and quality of life, the outcomes are not yet satisfactory. We report the case of a 54-year-old Japanese woman diagnosed with leptomeningeal metastases (LM) from a lung adenocarcinoma harboring an EGFR exon 21 L858R point mutation. She was treated with gefitinib for 2 months, and symptoms of LM emerged during the treatment period. Although the treatment was switched to erlotinib, disturbance of consciousness worsened because of progressive hydrocephalus. Because all extracranial lesions remained responsive to treatment, and the exon 20 T790M point mutation was not detected in cerebrospinal fluid, we placed a ventriculoperitoneal shunt. The patient’s disturbed consciousness improved dramatically after the shunt was placed; however, the optic and auditory nerve impairments due to direct invasion of LM lesions into nerve canals persisted. Administration of bevacizumab subsequent to whole-brain radiotherapy reduced the cranial nerve impairment, and the patient survived for 10 months. In conclusion, a combination of erlotinib and ventriculoperitoneal shunt was effective for hydrocephalus, and the immediate administration of additional therapies, including bevacizumab and radiation therapy, was useful in a patient suffering from LM.

Keywords: bevacizumab, erlotinib, ventriculoperitoneal shunt, leptomeningeal metastases, lung cancer, EGFR

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