Preliminary study on double ⁃ dose icotinib successfully treated leptomeningeal metastasis in lung adenocarcinoma patient with EGFR gene sensitive mutation

Abstract

Objective To report the diagnosis and treatment of a patient with meningeal metastases from lung adenocarcinoma, and explore the significance of cerebrospinal fluid (CSF) gene detection for clinical treatment and the efficacy and safety of double⁃dose icotinib in the treatment of meningeal metastases from lung adenocarcinoma with EGFR gene sensitive mutation. Methods and Results A 56⁃year⁃old female patient with meningeal metastasis from lung adenocarcinoma was examined for CSF and blood double⁃sample genes. The CSF had an exon 19 deletion mutation in the EGFR gene, and no sensitive mutations were found in blood sample. Oral icotinib hydrochloride 250 mg/time (3 times/d), and chest CT and head MRI enhanced scans were re⁃examined every 8 weeks, suggesting that the lung tumor was significantly reduced, and the degree of jumbo meningeal enhancement was lessened than before. Right lateral ventricle⁃peritoneal shunt was performed to effectively reduce intracranila pressure (ICP) and relieve clinical symptoms. Up to September 21, 2019, patient had been taking double doses of icotinib for 589 d, and her condition was stable. The main adverse drug reaction is rash. She is still taking medication and is being followed up. Conclusions For patients with meningeal metastases from lung adenocarcinoma, CSF gene detection of EGFR gene sensitive mutation can guide clinical development of treatment strategies. Double⁃dose icotinib is effective in treating meningeal metastases from lung adenocarcinoma with EGFR gene sensitive mutation, and is well tolerated and safe.

Keywords

• carcinoma non ⁃ small ⁃ cell lung
• neoplasm metastasis
• meninges
• receptor epidermal growth factor
• cerebrospinal fluid
• genes
• mutation
• drug therapy