Journal
JOURNAL OF THORACIC ONCOLOGY
Volume 4, Issue 11, Pages 1415-1419Publisher
ELSEVIER SCIENCE INC
DOI: 10.1097/JTO.0b013e3181b62572
Keywords
Lung cancer; Brain metastasis; EGFR-TKI; BBB; CNS
Categories
Funding
- Japan Society for the Promotion of Science [20903076]
- Kobayashi Institute for Innovative Cancer Chemotherapy
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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.
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