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International Cancer Conference Journal

, Volume 8, Issue 2, pp 81–85 | Cite as

Erlotinib and bevacizumab combination therapy for afatinib-refractory leptomeningeal carcinomatosis from EGFR-mutated lung cancer

  • Miyuki Abe
  • Atsushi Osoegawa
  • Takashi Karashima
  • Yohei Takumi
  • Ryoji Kobayashi
  • Takafumi Hashimoto
  • Michiyo Miyawaki
  • Hideya Takeuchi
  • Tatsuro Okamoto
  • Kenji SugioEmail author
Case report

Abstract

Acquired resistance to epidermal growth factor receptor tyrosine kinase inhibitors remains the main hurdle in treating EGFR-mutated lung cancer. Besides, when leptomeningeal carcinomatosis occurs during treatment, it often leads to treatment failure. We herein report a case of lung adenocarcinoma involving a patient with an EGFR exon 19 deletion mutation who developed leptomeningeal carcinomatosis after afatinib treatment for post-operative recurrence. He received right lower lobectomy, followed by four cycles of cisplatin and pemetrexed treatment. Follow-up CT/MRI revealed multiple pulmonary metastases and brain metastases at 7 months after surgery, and afatinib (40 mg/day) was administered after stereotactic radiotherapy for brain metastasis. At 28 months after surgery, follow-up MRI revealed asymptomatic leptomeningeal carcinomatosis, which was cytologically proven from the cerebrospinal fluid. Because EGFR T790M was not detected in plasma cell-free DNA or cerebrospinal fluid, erlotinib and bevacizumab combination treatment was administered. He remained asymptomatic and was radiographically clear of LM at 2 months after treatment. In comparison to other EGFR-TKIs, erlotinib shows penetrance into the cerebrospinal fluid. Furthermore, the addition of bevacizumab might enhance the treatment effect, because it is known to relieve brain edema from metastatic brain tumors by normalizing immature vascularity and improving drug penetrance into the cerebrospinal fluid by reducing interstitial fluid pressure.

Keywords

Leptomeningeal metastasis Erlotinib Bevacizumab EGFR mutation Non-small cell lung cancer 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© The Japan Society of Clinical Oncology 2019

Authors and Affiliations

  • Miyuki Abe
    • 1
  • Atsushi Osoegawa
    • 1
  • Takashi Karashima
    • 1
  • Yohei Takumi
    • 1
  • Ryoji Kobayashi
    • 1
  • Takafumi Hashimoto
    • 1
  • Michiyo Miyawaki
    • 1
  • Hideya Takeuchi
    • 1
  • Tatsuro Okamoto
    • 1
  • Kenji Sugio
    • 1
    Email author
  1. 1.Department of Thoracic and Breast SurgeryOita University Faculty of MedicineYufuJapan

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