Abstract
Leptomeningeal metastases (LM) occur in 5-10% of patients with solid tumors and are associated with a dismal prognosis. We describe LM from lung adenocarcinoma harboring a mutation in the epidermal growth factor receptor (EGFR) gene that confers sensitivity to the EGFR tyrosine kinase inhibitors (EGFR-TKIs) erlotinib and gefitinib. The CSF concentration of EGFR-TKIs achieved by standard daily dosing may be insufficient for therapeutic effect. However, intermittent (pulsatile) high dose administration (1000-1500 mg/week) achieves a higher CSF concentration than standard dosing, and successfully controlled LM in this patient.
Publication types
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Case Reports
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Research Support, N.I.H., Extramural
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Research Support, Non-U.S. Gov't
MeSH terms
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Adenocarcinoma / drug therapy*
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Adenocarcinoma / genetics
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Adenocarcinoma / secondary
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ErbB Receptors / antagonists & inhibitors
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ErbB Receptors / cerebrospinal fluid
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ErbB Receptors / genetics*
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Erlotinib Hydrochloride
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Female
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Humans
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Lung Neoplasms / drug therapy*
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Lung Neoplasms / genetics
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Lung Neoplasms / pathology
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Male
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Meningeal Neoplasms / drug therapy*
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Meningeal Neoplasms / genetics
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Meningeal Neoplasms / secondary
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Middle Aged
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Mutation / genetics*
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Protein Kinase Inhibitors / administration & dosage*
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Protein Kinase Inhibitors / blood
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Protein Kinase Inhibitors / cerebrospinal fluid
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Quinazolines / administration & dosage*
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Quinazolines / blood
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Quinazolines / cerebrospinal fluid
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Treatment Outcome
Substances
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Protein Kinase Inhibitors
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Quinazolines
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Erlotinib Hydrochloride
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EGFR protein, human
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ErbB Receptors