OncoTargets and Therapy (Jun 2022)

Leptomeningeal Metastatic L858R EGFR-mutant Lung Cancer: Prompt Response to Osimertinib in the Absence of T790M-mutation and Effective Subsequent Pulsed Erlotinib

  • Kanbour A,
  • Salih F,
  • Abualainin W,
  • Abdelrazek M,
  • Szabados L,
  • Al-Bozom I,
  • Omar NE

Journal volume & issue
Vol. Volume 15
pp. 659 – 667

Abstract

Read online

Aladdin Kanbour,1,* Faroug Salih,1,* Wafa Abualainin,2 Mohamed Abdelrazek,3 Lajos Szabados,3 Issam Al-Bozom,4 Nabil E Omar5,* 1Medical Oncology Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; 2Solid Tumor Section, Molecular Genetics Laboratory, Diagnostic Genomic Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar; 3Clinical Imaging Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar; 4Precision Medicine Section, Anatomical Pathology Department, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar; 5Pharmacy Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar*These authors contributed equally to this workCorrespondence: Nabil E Omar, Pharmacy Department, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, 3050, Qatar, Email [email protected]: Leptomeningeal carcinomatosis (LMC) is a known sequel of metastatic lung cancer and its treatment is challenging. Nevertheless, treatment options for LMC due to metastatic epidermal growth factor receptor-mutant (EGFR-mutant) lung adenocarcinoma are expanding. We present a 52-year-old male patient with metastatic non-small-cell lung cancer (NSCLC). The patient was found to have L858R mutation in exon 21 of the EGFR gene. He was initially treated with erlotinib, followed by afatinib/cetuximab, followed by chemotherapy. Thereafter, his disease progressed to LMC. Although tissue biopsy did not show T790M-mutation, osimertinib (160 mg once daily) promptly induced clinical and radiological response that continued for five months. High dose pulsed erlotinib (1500 mg weekly) improved his quality of life and extended his survival for a further four months.Keywords: NSCLC, non-small-cell lung cancer, LMC, leptomeningeal carcinomatosis, EGFR, epidermal growth factor receptor, EGFR-TKIs, EGFR tyrosine kinase inhibitors, osimertinib, pulsed erlotinib

Keywords