OncoTargets and Therapy (Sep 2019)
Treatment Response To Osimertinib In EGFR-Mutated Leptomeningeal Metastases From Non-Small Cell Lung Cancer: A Case Series
Abstract
Huiying Li,1,* Tingting Yu,1,* Mingmin Huang,1 Aibin Guo,1 Xiaoping Qian,2 Zhenyu Yin1 1Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, People’s Republic of China; 2The Comprehensive Cancer Center of Drum Tower Hospital, Clinical Cancer Institute of Nanjing University, Nanjing, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhenyu YinDepartment of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, No 321 Zhongshan Road, Nanjing, Jiangsu 210008, People’s Republic of ChinaTel +86 139 1390 4579Email [email protected] Xiaoping Qian The Comprehensive Cancer Center of Drum Tower Hospital, Clinical Cancer Institute of Nanjing University, No 321 Zhongshan Road, Nanjing, Jiangsu 210008, People’s Republic of ChinaTel +86 151 5067 1158Email [email protected]: Therapy for leptomeningeal metastases (LM) from non-small cell lung cancer (NSCLC) is challenging, and conventional treatments have little impact on the disease course. We report three cases that were definitively diagnosed as LM from NSCLC with a mutation of epidermal growth factor receptor (EGFR) L858R. The systemic therapies of chemotherapy, local radiotherapy, and early generation tyrosine kinase inhibitors (TKIs) were implemented but ineffective. Three patients were treated with the third-generation TKI osimertinib at 80 mg daily, despite their different detection levels of T790M in the cerebrospinal fluid (CSF) and plasma, and achieved symptomatic remission, a decline of carcinoembryonic antigen (CEA) levels, and stable lesions. After the progression of LM, osimertinib at 160 mg daily further lengthened the quality of life and survival time of patients without any notable side effects during treatment. Recent related studies and our cases indicate that osimertinib has a positive effect on LM from EGFR-mutant NSCLC, regardless of T790M status.Keywords: non-small cell lung cancer, leptomeningeal metastases, osimertinib, EGFR mutation, T790M
