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Non-small cell lung cancer leptomeningeal metastases treated with intrathecal therapy plus osimertinib and temozolomide and whole-brain radiation therapy: a case report
| Content Provider | Semantic Scholar |
|---|---|
| Author | Wang, Yunmei Liu, Shuguang Wei, Xiaohui Yan, Bin Li, Jun Su, Zhixiang Liu, Aiqin Zhang, Yanjun |
| Copyright Year | 2018 |
| Abstract | Rationale Leptomeningeal metastasis (LM) is an important cause of mortality in patients with non-small cell lung cancer (NSCLC). As the symptoms of LM and its early clinical manifestations are nonspecific, early diagnosis of LM is difficult. However, there are few treatment options for LM, which leads to a poor prognosis; thus, increased clinical attention is necessary. The effects of most systemic chemotherapies on metastatic brain tumors (brain metastases and LMs) are limited as they cannot pass the blood-brain barrier; therefore, whole-brain radiation therapy is a therapeutic option. Osimertinib is a potent and irreversible third-generation oral epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI). It binds to EGFR with high affinity when the EGFR T790M mutation is present together with sensitizing mutations. The clinical efficacy of osimertinib in NSCLC patients carrying the T790M mutation has been demonstrated in clinical trial NCT02468661. Intrathecal injection of chemotherapeutic drugs can be directed to a specific lesion. Temozolomide is one such drug, and its effect has been confirmed. Patient and interventions We treated a 38-year-old patient with NSCLC who carried the EGFR L858R mutation. We administered a combination of oral osimertinib and oral temozolomide plus an intrathecal injection of cytarabine and whole-brain radiation therapy for symptomatic multiple brain metastases. Outcomes The patient showed a marked response to this combination therapy. To date (after ~18 months), no recurrence or new lesions have been observed and he is asymptomatic. His disease-free survival surpasses that achieved with any monotherapy for LM. Lessons This is the first report to demonstrate the response to combination therapy in an NSCLC patient with LM. These findings indicate the potential utility of chemotherapy combined with radiotherapy combined with targeted therapy combined with local treatment, as each treatment acts via a different mechanism, enhancing their therapeutic effects. |
| Starting Page | 4733 |
| Ending Page | 4738 |
| Page Count | 6 |
| File Format | PDF HTM / HTML |
| PubMed reference number | 30127621v1 |
| Alternate Webpage(s) | https://doi.org/10.2147/OTT.S164968 |
| DOI | 10.2147/ott.s164968 |
| Journal | OncoTargets and therapy |
| Volume Number | 11 |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Blood - brain barrier anatomy Brain Neoplasms CNS metastases Chemotherapy Combined Modality Therapy Cytarabine EGFR NP_005219.2:p.L858R Early Diagnosis Forecast of outcome Growth Factor Receptors Intrathecal injection (procedure) Leptomeningeal Neoplasms Metastatic Malignant Neoplasm to the Leptomeninges Metastatic malignant neoplasm to brain Mutation Neoplasm Metastasis Non-Small Cell Lung Carcinoma Patients Protein Tyrosine Kinase Protein-tyrosine kinase inhibitor Receptor Protein-Tyrosine Kinases Small cell carcinoma of lung Targeted Therapy Therapeutic radiology procedure Whole-Brain Radiotherapy osimertinib temozolomide |
| Content Type | Text |
| Resource Type | Article |
