Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are effective for leptomeningeal metastasis from non-small cell lung cancer patients with sensitive EGFR mutation or other predictive factors of good response for EGFR TKI

Yi, Hyeon Gyu; Kim, Hye Jin; Kim, Yu Jung; Han, Sae‐Won; Oh, Do‐Youn; Lee, Se‐Hoon; Kim, Dong-Wan; Im, Seock‐Ah; Kim, Tae-You; Kim, Chul Soo; Heo, Dae Seog; Bang, Yung‐Jue

doi:10.1016/j.lungcan.2008.10.016

Cited by 112 publications

(79 citation statements)

References 20 publications

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“…In fact, some patients with leptomeningeal carcinomatosis harboring EGFR mutation who were treated with EGFR-TKI with concomitant administration of intrathecal chemotherapy and WBRT showed relatively long-term survival. However, unlike the present case, those patients did not receive EGFR-TKI prior to diagnosis of leptomeningeal carcinomatosis (10). Thus, it is difficult to exclude the possibility that VP shunting and concurrent WBRT contributed to the relatively long survival seen in these cases.…”

Section: Discussioncontrasting

confidence: 60%

Long-term Outcome after Multidisciplinary Approach for Leptomeningeal Carcinomatosis in a Non-small Cell Lung Cancer Patient with Poor Performance Status

et al. 2011

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The present study describes a case of a 60-year-old Japanese man who was histologically diagnosed with lung adenocarcinoma harboring L858R mutation of epidermal growth factor receptor. He was successfully treated with gefitinib, but eventually developed leptomeningeal carcinomatosis. He underwent ventriculoperitoneal shunting for hydrocephalus and received erlotinib in place of gefitinib with concurrent whole brain radiotherapy; this resulted in dramatic improvement in his symptoms and performance status from four to one and he survived for as long as 13.6 months after the initiation of erlotinib therapy. This multidisciplinary approach may be particularly useful in terms of increasing survival and improving quality of life.

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Section: Discussioncontrasting

confidence: 60%

Long-term Outcome after Multidisciplinary Approach for Leptomeningeal Carcinomatosis in a Non-small Cell Lung Cancer Patient with Poor Performance Status

et al. 2011

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“…None of the mentioned studies selected the patients for treatment according to the mutational status of the EGFR gene, or carried out this analysis. It has been pointed out that gefitinib may have an incomplete penetration though the blood-brain barrier [26] and its effectiveness for the treatment of brain metastasis may depend on the disruption of the barrier [27].…”

Section: Discussionmentioning

confidence: 99%

Brain metastases from lung cancer responding to erlotinib: the importance of EGFR mutation

Porta¹,

Sánchez-Torres²,

Paz‐Ares³

et al. 2010

European Respiratory Journal

280

163

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Median survival of patients with brain metastases from nonsmall cell lung cancer (NSCLC) is poor and more effective treatments are urgently needed. We have evaluated the efficacy of erlotinib in this setting and its association with activating mutations in the epidermal growth factor receptor (EGFR) gene.We retrospectively identified patients with NSCLC and brain metastases treated with erlotinib. EGFR mutations in exons 19 and 21 were analysed by direct sequencing. Efficacy and tolerability were compared according to EGFR mutational status.69 NSCLC patients with brain metastases were identified, 17 of whom harboured EGFR mutations. Objective response rate in patients with EGFR mutations was 82.4%; no responses were observed in unselected patients (p,0.001). Median (95% CI) time to progression within the brain for patients harbouring EGFR mutations was 11.7 (7.9-15.5) months, compared to 5.8 (5.2-6.4) months for control patients whose EGFR mutational status had not been assessed (p,0.05). Overall survival was 12.9 (6.2-19.7) months and 3.1 (2.5-3.9) months (p,0.001), respectively. The toxicity of erlotinib was as expected and no differences between cohorts were observed.Erlotinib is active in brain metastases from NSCLC; this clinical benefit is related to the presence of activating mutations in exons 19 or 21 of the EGFR gene.

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“…The reasons for the differences between these studies are unclear. In recent years, many studies (24,25,(51)(52)(53) have reported that the clinical therapeutic effects of TKIs are closely associated with EGFR mutations in NSCLC patients. In a clinical study by Shepherd et al (54), 731 patients with NSCLC were randomly treated with oral Tarceva (150 mg/day) and a placebo at the ratio of 2:1 until the ocurrence of disease progression or unacceptable toxicity.…”

Section: Discussionmentioning

confidence: 99%

EGFR mutations predict a favorable outcome for malignant pleural effusion of lung adenocarcinoma with Tarceva therapy

Guo

Wan²,

Tian³

et al. 2011

Oncol Rep

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Abstract. The aim of the present study was to evaluate the therapeutic effects and adverse reactions of Tarceva treatment for malignant pleural effusion (MPE) caused by metastatic lung adenocarcinomas. One hundred and twenty-eight patients who failed first-line chemotherapy drug treatment were divided into a mutation and a non-mutation group according to the presence or absence of epidermal growth factor receptor (EGFR) mutations. Each patient received closed drainage combined with simple negative pressure suction after thoracoscopic talc poudrage pleurodesis and oral Tarceva treatment. Short-term and long-term clinical therapeutic effects of Tarceva were evaluated. The EGFR mutation rate in pleural metastatic tissues of lung adenocarcinoma acquired through video-assisted thoracoscopic surgery was higher compared to that in surgical resection specimens, plasma specimens and pleural effusion specimens compared to previously reported results. There were significant statistical differences in the average extubation time (p<0.01), drainage volume of pleural effusion (p<0.05), Karnofsky score and formation of encapsulated pleural effusion 4 weeks after surgery (p<0.05) between these two groups. The number of patients with mild pleural hypertrophy in the mutation group was significantly higher compared to the non-mutation group (p<0.01), while the number of patients with severe pleural hypertrophy was significantly reduced (p<0.05). There was significant statistical discrepancy between these two groups in terms of improvement of peripheral blood carcinoembryonic antigen and tissue polypeptide antigen after 4 weeks of therapy. The complete remission rate and the efficacy rate were higher in the mutation group compared to that in the non-mutation group (p<0.05). There was a longer overall survival time after Tarceva treatment in patients with EGFR mutations than those without EGFR mutation. EGFR mutations predict a favorable outcome for malignant pleural effusion of lung adenocarcinoma with Tarceva therapy. Detection of EGFR mutations may determine the responsiveness of malignant pleural effusion to Tarceva treatment.

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Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are effective for leptomeningeal metastasis from non-small cell lung cancer patients with sensitive EGFR mutation or other predictive factors of good response for EGFR TKI

Cited by 112 publications

References 20 publications

Long-term Outcome after Multidisciplinary Approach for Leptomeningeal Carcinomatosis in a Non-small Cell Lung Cancer Patient with Poor Performance Status

Long-term Outcome after Multidisciplinary Approach for Leptomeningeal Carcinomatosis in a Non-small Cell Lung Cancer Patient with Poor Performance Status

Brain metastases from lung cancer responding to erlotinib: the importance of EGFR mutation

EGFR mutations predict a favorable outcome for malignant pleural effusion of lung adenocarcinoma with Tarceva therapy

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