Successful treatment of carcinomatous meningitis with erlotinib and whole brain radiotherapy

Abstract

Carcinomatous meningitis (CM) is a severe complication of lung cancer. Here, we report on two EGFR-mutated patients who attained relatively long survivals by erlotinib treatment after diagnosis of CM. The first case is a 59-year-old woman who was diagnosed as adenocarcinoma harboring an EGFR mutation (L858R); her disease was at stage IV with multiple brain metastases. The time from the initial diagnosis of lung cancer to CM was 364 days. Erlotinib was administered for 5 months, and the survival time from the diagnosis of CM was 278 days. The second case is a 60-year-old man who underwent right lower lobe lobectomy and was diagnosed as adenocarcinoma with an EGFR mutation (E746-750 deletion) and at the pathological stage IIA (pT1N2M0). Later, the disease was recurring as brain metastasis, and progressed to CM 637 days after diagnosis of lung cancer. Erlotinib was administered for 5.5 months, and the survival time from the diagnosis of CM was 281 days. These cases indicate that erlotinib is a reasonable option for the treatment of CM in EGFR-mutated patients.

Osimertinib is associated with improved outcomes in pre-treated non-small cell lung cancer leptomeningeal metastases: A systematic review and meta-analysis

“…Following the initial screening process, which involved removing ineligible articles and supplementing with studies from authors’ files, a total of 128 publications were ultimately included in the meta-analysis ( Appendix B and Appendix C ). 106 of the publications were case reports [ [14] , [15] , [16] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , [90] , [91] , [92] , [93] , [94] , [95] , [96] , [97] , [98] , …”

Long‐term survival of a patient with carcinomatous meningitis caused by non‐small cell lung cancer: The advantage of absence of primary tumor recurrence

“…Several reports have recently described the effectiveness of EGFR‐TKI in patients with CM originating from lung adenocarcinoma with EGFR mutations . The use of EGFR‐TKI was proven to confer the survival benefit of patients with CM originating from non‐small cell lung cancer (NSCLC) in some retrospective studies .…”

“…Several reports have recently described the effectiveness of EGFR-TKI in patients with CM originating from lung adenocarcinoma with EGFR mutations. [2][3][4] The use of EGFR-TKI was proven to confer the survival benefit of patients with CM originating from non-small cell lung cancer (NSCLC) in some retrospective studies. [5][6][7] In contrast with the long-term survival of this patient, Umemura et al 7 showed that the median survival time of patients with CM originating from NSCLC without EGFR mutations was 1.4 months, which was significantly shorter than that of patients with EGFR mutations.…”

“…The prognosis of patients with carcinomatous meningitis (CM) is very poor, and the median survival is reported as 4–6 weeks without therapy and 2–3 months with any therapy, although epidermal growth factor receptor (EGFR)‐tyrosine kinase inhibitors (TKI) such as erlotinib and gefitinib have recently prolonged survival in CM patients with mutations of the EGFR gene . Here, we report a patient who survived for 29.6 months from the diagnosis of CM despite being treated by only conventional radiation therapy and chemotherapy without EGFR‐TKI.…”