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Efficacy of erlotinib for brain and leptomeningeal metastases in patients with lung adenocarcinoma who showed initial good response to gefitinib.

Katayama T, Shimizu J, Suda K, Onozato R, Fukui T, Ito S, Hatooka S, Sueda T, Hida T, Yatabe Y, Mitsudomi T ...see all

Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer, vol. 4, issue 11 (2009) pp. 1415-9

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INTRODUCTION: The efficacy of high-dose (1250 mg/d) gefitinib for the treatment of leptomeningeal metastasis in a patient with lung cancer harboring a mutation in the epidermal growth factor receptor (EGFR) gene was previously reported. We speculate that erlotinib, instead of high dose of gefitinib, may be also effective for the treatment of central nervous system (CNS) lesions, as trough serum concentration of erlotinib is nine times higher than that of gefitinib.

PATIENTS AND METHODS: Patients with lung cancer in whom CNS lesions developed after an initial good response to gefitinib for extra CNS lesions were enrolled in the study. Tumor response, performance status, neurologic symptoms, and survival were retrospectively evaluated.

RESULTS: All seven patients had EGFR mutations in their primary tumors except one patient. The median interval between gefitinib withdrawal and erlotinib administration was 5 days. Three patients showed partial response, three had stable disease, and one had progressive disease. Performance status and symptoms improved in five patients. The overall survival from the initiation of erlotinib treatment ranged from 15 to 530 days (median, 88 days).

CONCLUSIONS: Erlotinib was a reasonable option for the treatment of CNS diseases that appeared after a good initial response of extra CNS disease to gefitinib.

Author-supplied keywords

  • Adenocarcinoma
  • Adenocarcinoma: drug therapy
  • Adenocarcinoma: genetics
  • Adenocarcinoma: secondary
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents
  • Antineoplastic Agents: therapeutic use
  • Biomarkers, Tumor
  • Biomarkers, Tumor: genetics
  • Brain Neoplasms
  • Brain Neoplasms: drug therapy
  • Brain Neoplasms: genetics
  • Brain Neoplasms: secondary
  • DNA, Neoplasm
  • DNA, Neoplasm: analysis
  • Erlotinib Hydrochloride
  • Female
  • Follow-Up Studies
  • Humans
  • Lung Neoplasms
  • Lung Neoplasms: drug therapy
  • Lung Neoplasms: genetics
  • Lung Neoplasms: pathology
  • Male
  • Meningeal Neoplasms
  • Meningeal Neoplasms: drug therapy
  • Meningeal Neoplasms: genetics
  • Meningeal Neoplasms: secondary
  • Middle Aged
  • Mutation
  • Protein Kinase Inhibitors
  • Protein Kinase Inhibitors: therapeutic use
  • Quinazolines
  • Quinazolines: therapeutic use
  • Receptor, Epidermal Growth Factor
  • Receptor, Epidermal Growth Factor: antagonists & i
  • Receptor, Epidermal Growth Factor: genetics
  • Retrospective Studies
  • Spinal Cord Neoplasms
  • Spinal Cord Neoplasms: drug therapy
  • Spinal Cord Neoplasms: genetics
  • Spinal Cord Neoplasms: secondary
  • Treatment Outcome

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  • Tatsuya Katayama

  • Junichi Shimizu

  • Kenichi Suda

  • Ryoichi Onozato

  • Takayuki Fukui

  • Simon Ito

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