Long-Term Treatment with Erlotinib for EGFR Wild-Type Non-Small Cell Lung Cancer: A Case Report

Abstract

The epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) gefitinib and erlotinib are known to have greater efficacy in EGFR mutation-positive non-small cell lung cancer (NSCLC), although erlotinib also has activity in wild-type disease. We report the successful long-term maintenance treatment of a patient with EGFR wild-type NSCLC with gefitinib and later erlotinib. The patient (male; 44 years old; smoker) was diagnosed with EGFR wild-type NSCLC after computer tomography had revealed a mediastinal mass, and histology and mutation testing had identified the tumor as an EGFR wild-type grade 3 adenocarcinoma. The patient received multiple rounds of chemotherapy, followed by gefitinib maintenance (3 years). Later on, he received erlotinib maintenance and developed a persistent rash (grade 1/2) that lasted throughout the treatment. The patient's condition has remained stable on erlotinib for more than 5 years, with no evidence of progression. We describe the patient's disease course and treatment in the context of EGFR TKI therapy and the prognostic factors for long-term clinical outcomes of NSCLC, including the development of erlotinib-induced rash.

Long-term disease stabilization following treatment with erlotinib in heavily pretreated patients with wild-type epidermal growth factor receptor non-small-cell lung carcinoma: Two case reports

“…From a clinical perspective, our patients, as well as one other case previously reported in the literature that exceeded 5 years of disease stabilization, exhibited no spread of the disease to the liver, bones, or adrenal glands, despite the long course of their disease (10). By contrast, they were mainly characterized by bulky nodal disease, pointing towards tumors with a predisposition to lymphatic spread, and a relative inability for hematogenous spread.…”

Effects of Cigarette Smoking on Metabolism and Effectiveness of Systemic Therapy for Lung Cancer

“…It is also unclear whether EGfR-wild type patients may be targeted by increasing the half maximal inhibitory concentration (IC 50 ) of EGfR inhibitors and such studies are also underway. 74,75 Although the magnitude of PfS improvement was not as great as those patients with EGfR mutations, for this group of patients, one could consider differential dosing of erlotinib based on smoking status. In summary, the use of erlotinib in advanced lung adenocarcinoma is currently approved for patients with an activating EGfR mutation.…”

A Case Study and Literature Review: Adenocarcinoma of the Lung

“…Our patient, who was diagnosed with adenocarcinoma of the right lung stage IV, has been effectively treated with erlotinib in monotherapy for almost 6 years. To the best of our knowledge, this is probably one of the longest surviving patient with Non-Small-Cell Lung cancer [5,6]. After the failure of initial chemotherapy regimens (cisplatin with gemcitabine and then docetaxel), it was possible to start third-line effective treatment with targeted therapy -erlotinib.…”

“…Additionally, scans did not revealed metastatic disease. In the initial period of therapy the patient was not taking any other medications aside from erlotinib [5][6][7].…”