内容紹介
A Case of Lung Adenocarcinoma Presenting with Leptomeningeal Carcinomatosis Successfully Treated with Afatinib after Erlotinib-Induced Hepatotoxicity
Summary
A 65-year-old man was diagnosed with leptomeningeal carcinomatosis based on the findings of cerebrospinal fluid cytology and magnetic resonance imaging(MRI). Treatment with erlotinib and bevacizumab was initiated, and partial improvement in consciousness and MRI findings were obtained. However, it was difficult to continue the treatment because of elevation in levels of liver enzymes and melena. We switched the treatment to afatinib monotherapy, and his consciousness improved immediately. Progression-free survival and overall survival from the initiation of the treatment with afatinib were 7 and 9.4 months, respectively. This clinical course suggests activity of afatinib for central nervous system lesions of EGFR-mutated lung cancer.
要旨
症例は65歳,男性。肺腺癌および癌性髄膜炎と診断され,エルロチニブとベバシズマブの併用により頭部MRI所見と意識障害の部分的な改善が得られたが,肝障害と黒色便のため治療継続が困難となった。アファチニブの投与を開始した後,急速に意識障害が改善し,肝障害は認められなかった。アファチニブ投与開始からの無増悪生存期間は7か月,全生存期間は9.4か月であった。EGFR遺伝子変異陽性非小細胞肺癌症例におけるアファチニブの中枢神経系病変に対する効果が示唆された。
目次
Summary
A 65-year-old man was diagnosed with leptomeningeal carcinomatosis based on the findings of cerebrospinal fluid cytology and magnetic resonance imaging(MRI). Treatment with erlotinib and bevacizumab was initiated, and partial improvement in consciousness and MRI findings were obtained. However, it was difficult to continue the treatment because of elevation in levels of liver enzymes and melena. We switched the treatment to afatinib monotherapy, and his consciousness improved immediately. Progression-free survival and overall survival from the initiation of the treatment with afatinib were 7 and 9.4 months, respectively. This clinical course suggests activity of afatinib for central nervous system lesions of EGFR-mutated lung cancer.
要旨
症例は65歳,男性。肺腺癌および癌性髄膜炎と診断され,エルロチニブとベバシズマブの併用により頭部MRI所見と意識障害の部分的な改善が得られたが,肝障害と黒色便のため治療継続が困難となった。アファチニブの投与を開始した後,急速に意識障害が改善し,肝障害は認められなかった。アファチニブ投与開始からの無増悪生存期間は7か月,全生存期間は9.4か月であった。EGFR遺伝子変異陽性非小細胞肺癌症例におけるアファチニブの中枢神経系病変に対する効果が示唆された。