Response of Erlotinib in Lung Adenocarcinoma Harboring EGFR Sensitive Mutation in Cerebrospinal Fluid: Case Report

Abstract

Background and objective One of the most often distance metastasis site of non-small cell lung cancer (NSCLC) is brain and the standard treatment of brain metastasis was radiotheraphy including whole brain irradiation (WBI) and stereotactic radiotherapy (SRT). It has been reported that epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) had the active response in brain metastasis of lung cancer. In the present study, we reported one case of EGFR 19el in cerebrospinal fluid tested by ARMS got partial response given erlotinib. Methods Cerebrospinal fluid was collected through lumbar puncture, then cast-off cells and EGFR mutation was analysed. Erlotinib was given with dose of 150 mg, qd. Objective response was evaluated by Response Evaluation Criteriation in Solid Tumours (RECIST) v1.1 and adeverse events were evaluated according to Common Terminology Criteria for Adverse Events v4.0 (CTC AE v4.0). Results Heterocyst cells were found in cerebrospinal fluid and EGFR mutation was tested as 19del. The patient achieved partial response (PR) of brain metastasis and the effective response in lung was stable disease (SD) after 4 weeks of erlotinib. The progression-free survival (PFS) and overall survival (OS) of brain metastasis was 10.5 months and 11 months respectively. The main adverse event was rash (Grade I). Conclusion It was feasible to test EGFR mutation in cerebrospinal fluid and the combination of erlotinib with chemotheraphy would be an appropriate choice to those lung cancer patients who had brain metastasis harboring EGFR sensitive mutation.

Keywords

• ung neoplasms
• Brain metastasis
• Cerebrospinal fluid
• Epidermal growth factor receptor tyrosine kinase inhibitors
• Objective response rate