Gefitinib and a ventriculo-peritoneal shunt to manage carcinomatous meningitis from non-small-cell lung cancer: Report of two cases

Abstract

The prognosis of patients with carcinomatous meningitis from non-small-cell lung cancer (NSCLC) remains poor, and the available treatment options for the lung cancer do not relieve the severe symptoms of this sequela. We report the successful treatment of two cases of carcinomatous meningitis caused by NSCLC, using gefitinib and a ventriculo-peritoneal (V-P) shunt. The first patient was a 43-year-old woman with pT1N0M0 adenocarcinoma. Multiple brain and vertebral metastases were found 13 months after surgery. She had undergone gamma-knife radiosurgery for the brain metastases, radiotherapy for the vertebral metastases, and two regimens of systemic chemotherapy, before carcinomatous meningitis was diagnosed. She was given gefitinib, and then a V-P shunt was placed. She continued to take gefitinib and was free of subjected symptoms for 5 months until she died. The second patient was a 64-year-old woman with cT4N0M0 adenocarcinoma. After local chemotherapy using cisplatin and OK-432 for carcinomatosis pleuritis and two regimens of systemic chemotherapy, carcinomatous meningitis was detected. A V-P shunt was placed, and she was sequentially given gefitinib. At her 15-month follow-up, she was free of symptoms of carcinomatous meningitis. No adverse effects or shunt problems were detected in either patient. This therapeutic modality may liberate carcinomatous meningitis patients with severe symptoms from hospitalization and improve their quality of life.

Whole brain radiation therapy does not improve the overall survival of EGFR-mutant NSCLC patients with leptomeningeal metastasis

“…In our study, 23 of 30 developed LM during treatment with EGFR-TKI. After the diagnosis of LM, the 36 patients who received EGFR-TKIs achieved significantly longer iPFS LM and OS LM than patients who did not (median iPFS LM 3.9 vs. 2.7 months, p = 0.019; median OS LM 10 vs. 3.3 months, p = 0.002), and these findings are consistent with those from previous studies [5, 6, 22, 23]. Li et al [5] showed that patients who received EGFR-TKIs after LM diagnosis had significantly longer survival compared with those who did not (10.0 vs. 3.3 months; p < 0.001).…”

Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors for Non–Small-Cell Lung Cancer Patients with Leptomeningeal Carcinomatosis

“…11 Some authors have reported that EGFR TKIs were effective in treating LC in patients with EGFR mutations. [12][13][14] In several retrospective studies, EGFR TKI therapy for LC was found to prolong survival, but the impact of EGFR mutations was not clear because of the small number of patients who underwent EGFR gene testing. [15][16][17][18][19][20] Gefitinib and erlotinib were available commercially in Taiwan in 2003 and 2006, respectively, to treat metastatic lung cancer.…”

Medical Management of Brain Metastases from Lung Cancer

“…These findings might provide valuable information for the management of gefitinib-responders. Although the survival benefit is controversial, gefitinib may also be useful for the treatment of carcinomatous meningitis from NSCLC to improve neurological dysfunction (41,42,43 …”