The epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) erlotinib improves survival of lung cancer as second-or third-line therapy. However, after an initial response, most patients will recur, particularly within the central nervous system.The present study reports the case of a 27-yr-old nonsmoking male presenting with a metastatic lung adenocarcinoma with EGFR exon 19 deletion, associated with sensitivity to EGFR-TKI. Gefitinib, followed by chemotherapy and finally erlotinib resulted in prolonged disease control, until multiple liver metastases were detected. After stopping EGFR-TKI, brain metastases with carcinomatous meningitis were diagnosed. A secondary T790M mutation, associated with resistance to EGFR-TKI, was found on the liver biopsy but not in the cerebrospinal fluid. Erlotinib was reintroduced and allowed a quick neurological improvement, even though the extracranial disease remained resistant to erlotinib.The present report underscores the interest of molecular monitoring in lung cancer. Persistent cerebral tyrosine kinase inhibitor sensitivity should be considered in patients presenting with an early central nervous system relapse after stopping epidermal growth factor receptor tyrosine kinase inhibitor, even with a T790M-resistant mutation in noncerebral metastases. Questions remain concerning the selection of sub-clones during epidermal growth factor receptor tyrosine kinase inhibitor therapy, which could differ according to metastatic sites, especially in the central nervous system.
This two-step study evaluated the cost-effectiveness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for presurgery staging of non-small cell lung cancer (NSCLC) in France (EVIEPEB; ClinicalTrial.gov identifier NCT00960271).Step 1 consisted of a high-benchmark EBUS-TBNA–training program in participating hospital centers. Step 2 was a prospective, national, multicenter study on patients with confirmed or suspected NSCLC and an indication for mediastinal staging with at least one lymph node > 1 cm in diameter. Patients with negative or uninformative EBUS-TBNA and positron-emission tomography-positive or -negative nodes, respectively, underwent either mediastinoscopy or surgery. Direct costs related to final diagnosis of node status were prospectively recorded.Sixteen of 22 participating centers were certified by the EBUS-TBNA–training program and enrolled 163 patients in Step 2. EBUS-TBNA was informative for 149 (91%) patients (75 malignant, 74 non-malignant) and uninformative for 14 (9%). Mediastinoscopy was avoided for 80% of the patients. With a 52% malignant-node rate, EBUS-TBNA positive- and negative-predictive values, respectively, were 100% and 90%. EBUS-TBNA was cost-effective, with expected savings of €1,450 per patient, and would have remained cost-effective even if all EBUS-TBNAs had been performed under general anesthesia or the cost of the procedure had been 30% higher (expected cost-saving of €994 and €1,427 per patient, respectively).After EBUS-TBNA training and certification of participating centers, the results of this prospective multicenter study confirmed EBUS-TBNA cost-effectiveness for NSCLC staging.
P haryngolaryngeal sarcoidosis (PLS) can be integrated in a multisystemic sarcoidosis or more exceptionally can be isolated. Course, natural history, and long-term prognosis are poorly understood. 1,2 18 F-Fluorodeoxyglucose positron emission tomography coupled with CT (18F-FDG PET/CT) is a noninvasive imaging tool with a potential role in management of thoracic and extrathoracic sarcoidosis. Nevertheless, the usefulness of 18F-FDG PET/CT has not been completely evaluated for PLS. [3][4][5]
METHODS AND MATERIALSTwelve consecutive patients with biopsy-proven PLS were retrospectively included in this study. Assessment for inclusion involved: 1) complete clinical and endoscopic evaluation, 2) measurement of serum angiotensin-converting enzyme (SACE), 3) high-resolution sinonasal, neck, and thoracic CT, 4) PET/CT in six patients, and 5) 46 biopsies of macroscopically visible lesions (Table 1). The treatment involved oral corticosteroid therapy in 11 cases, associated with immunosuppressive drugs in four of these cases. The corticosteroids (0.5-1 mg/kg daily of prednisolone) in tapering doses were maintained for months or years according to the evolution of PLS and other associated sarcoidosis localizations. Four patients also underwent surgical procedure: microsurgery of the vocal cords in three cases and recalibration of the larynx in one case. The average follow-up was 5 years and included clinical and endoscopic investigations, CT, SACE measurement, and PET/CT after treatment in four cases. The study was approved by the
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.