Good outcome of salvage operation for stage IV lung cancer following gefitinib administration and thoracic spine metastasectomy

Abstract

Background. In the Japanese Lung Cancer guidelines, gefitinib is recommended as a first-line or later chemotherapy drug for patients with epidermal growth factor receptor (EGFR) mutation-positive advanced or recurrent non-small cell lung cancer. However, acquired drug resistance is common. Case. A 65-year-old woman complaining of back pain was admitted to our hospital. She had a metastatic bone tumor in her thoracic spine area and underwent metastasectomy. Chest computed tomography also revealed a lung tumor in the left lower lobe. A pathological examination of the excised spine tumor resulted in a diagnosis of metastatic cancer from lung adenocarcinoma (cT1N0M1, c-stage IV). Gefitinib was administered following 2 courses of carboplatin (CBDCA) + paclitaxel (PTX). The lung tumor shrank following gefitinib administration, but then grew slowly during the subsequent 6 years. Thereafter, bronchofiberscopic examination revealed adenocarcinoma with T790M-tolerant gene expression. As no distant metastasis was observed, we considered that the primary tumor, but not the metastasis, had become resistant to gefitinib, and therefore, we performed a left lower lobectomy and lymph node dissection. The patient was disease-free at 20 months after the second operation. Conclusion. We achieved a good outcome in salvage surgery for stage IV non-small cell lung cancer following long-term control by gefitinib and thoracic spine metastasectomy. Salvage surgery should be considered when acquired resistance is localized in the primary tumor site. © 2012 The Japan Lung Cancer Society.