Gefitinib response of erlotinib-refractory lung cancer involving meninges - Role of EGFR mutation

Nicholas W. Choong, Sascha Dietrich, Tanguy Y. Seiwert, Maria S. Tretiakova, Vidya Nallasura, Gareth C. Davies, Stanley Lipkowitz, Aliya N. Husain, Ravi Salgia, Patrick C. Ma

Research output: Contribution to journalArticlepeer-review

111 Scopus citations


Background: A 70-year-old Japanese -American woman who had never smoked was diagnosed with stage IV non-small-cell lung cancer with rib metastases. She had previously been well and she had no family history of malignancy. While receiving treatment with erlotinib, an epidermal growth factor receptor small-molecule inhibitor, she progressed and developed new brain metastases. She failed further chemotherapy treatments and subsequently developed extensive symptomatic leptomeningeal carcinomatosis associated with diplopia, hemiparesis, weight loss, and incontinence. Investigations: Chest X-ray, head and chest CT scan, R2 lymph-node biopsy, histopathology, immunohistochemistry, MRI of head and spine, lumbar puncture, laser microdissection and EGFR genomic DNA sequencing of the R2 lymph node and cerebrospinal fluid tumor cells. Diagnosis: Erlotinib-refractory stage IV lung adenocarcinoma and end-stage symptomatic leptomeningeal metastases with a novel double L858R + E884K somatic mutation of the EGFR. Management: Carboplatin, paclitaxel and erlotinib, whole-brain radiotherapy, temozolomide with and without irinotecan, and gefitinib.

Original languageEnglish (US)
Pages (from-to)50-57
Number of pages8
JournalNature Clinical Practice Oncology
Issue number1
StatePublished - Jan 2006

All Science Journal Classification (ASJC) codes

  • Oncology


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