Abstract
Background A 70-year-old Japanese–American woman who had never smoked was diagnosed with stage IV non-small-cell lung cancer with rib metastases. She had previously been well and she had no family history of malignancy. While receiving treatment with erlotinib, an epidermal growth factor receptor small-molecule inhibitor, she progressed and developed new brain metastases. She failed further chemotherapy treatments and subsequently developed extensive symptomatic leptomeningeal carcinomatosis associated with diplopia, hemiparesis, weight loss, and incontinence.
Investigations Chest X-ray, head and chest CT scan, R2 lymph-node biopsy, histopathology, immunohistochemistry, MRI of head and spine, lumbar puncture, laser microdissection and EGFR genomic DNA sequencing of the R2 lymph node and cerebrospinal fluid tumor cells.
Diagnosis Erlotinib-refractory stage IV lung adenocarcinoma and end-stage symptomatic leptomeningeal metastases with a novel double L858R + E884K somatic mutation of the EGFR.
Management Carboplatin, paclitaxel and erlotinib, whole-brain radiotherapy, temozolomide with and without irinotecan, and gefitinib.
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Acknowledgements
S Dietrich is supported by a Boehringer Ingelheim Foundation Research Fellowship, Germany. TY Seiwert is supported by a CALGB research grant award. GC Davies and S Lipkowitz are supported by the Intramural Research Program of the NIH, National Cancer Institute, Center for Cancer Research. R Salgia is supported by NIH/NCI-R01 award, American Cancer Society Award (National), and Institutional Cancer Research Awards from the University of Chicago Cancer Center with the American Cancer Society and the V-Foundation. PC Ma is supported by NIH/NCI-K08 award, the American Association for Cancer Research–AstraZeneca–Cancer Prevention and Treatment Translational Lung Cancer Research Fellowship, and American Cancer Society (Illinois Division)-LUNGevity Foundation Lung Cancer Treatment Research Award.
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Choong, N., Dietrich, S., Seiwert, T. et al. Gefitinib response of erlotinib-refractory lung cancer involving meninges—role of EGFR mutation. Nat Rev Clin Oncol 3, 50–57 (2006). https://doi.org/10.1038/ncponc0400
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DOI: https://doi.org/10.1038/ncponc0400
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