CNS response after erlotinib therapy in a patient with metastatic NSCLC with an EGFR mutation

Minggui Pan*, Monica Santamaria and David B Wollman

For patients with non-small-cell lung cancer (NSCLC) and brain metastasis, effective treatment strategies are required because systemic chemotherapy is usually ineffective. Pan and colleagues present the case of a 73-year-old man who was diagnosed with NSCLC with brain metastasis, who carried an EGFR mutation and was managed with erlotinib and whole-brain irradiation. The authors discuss the treatment options for patients with metastatic NSCLC and propose erlotinib as an appropriate therapy for patients with a high probability of harboring classic EGFR mutations.

Background A 73-year-old Asian man with a history of lipidemia, hypertension and myocardial infarction presented with dizziness, decreased appetite, weight loss, nonproductive cough and fatigue. His physical performance status was good, and physical examination was unremarkable except for lower-extremity pitting edema.

Investigations Physical examination, brain MRI, CT scans of the chest, abdomen and pelvis, bone scan, CT scan-guided biopsy, hematoxylin and eosin staining, EGFR mutational analysis, and chest X-ray.

Diagnosis Stage IV non-small-cell lung cancer with brain metastasis.

Management Oral erlotinib 150 mg daily for 10 months and ongoing, and whole-brain irradiation.

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