Treatment Response To Osimertinib In EGFR -Mutated Leptomeningeal Metastases From Non-Small Cell Lung Cancer: A Case Series

• Published in: OncoTargets and therapy Vol. 12; pp. 7785 - 7790
• Main Authors: Li, Huiying, Yu, Tingting, Huang, Mingmin, Guo, Aibin, Qian, Xiaoping, Yin, Zhenyu
• Format: Journal Article
• Language: English
• Published: Macclesfield Dove Medical Press Limited 01-09-2019; Taylor & Francis Ltd; Dove
• Subjects: Afatinib; Antigens; Back pain; Brain cancer; Cancer metastasis; Cancer therapies; Cancer treatment; Carcinoembryonic antigen; Care and treatment; Case Series; Cellular biology; Cerebrospinal fluid; Chemotherapy; Crizotinib; Dacomitinib; Epidermal growth factor; Epidermal growth factor receptors; Epidermal growth factors; Geriatrics; Lung cancer; Meninges; Metastases; Metastasis; Mutation; NMR; Non-small cell lung cancer; Non-small cell lung carcinoma; Nuclear magnetic resonance; Oncology; Osimertinib; Patients; Phenols (Class of compounds); Plasma; Protein-tyrosine kinase; Quality of life; Radiation therapy; Radiotherapy; Remission; Small cell lung cancer; Small cell lung carcinoma; Targeted cancer therapy; Tyrosine; China
• ISSN: 1178-6930; 1178-6930
• DOI: 10.2147/OTT.S199452

Therapy for leptomeningeal metastases (LM) from non-small cell lung cancer (NSCLC) is challenging, and conventional treatments have little impact on the disease course. We report three cases that were definitively diagnosed as LM from NSCLC with a mutation of epidermal growth factor receptor (EGFR) L858R. The systemic therapies of chemotherapy, local radiotherapy, and early generation tyrosine kinase inhibitors (TKIs) were implemented but ineffective. Three patients were treated with the third-generation TKI osimertinib at 80 mg daily, despite their different detection levels of T790M in the cerebrospinal fluid (CSF) and plasma, and achieved symptomatic remission, a decline of carcinoembryonic antigen (CEA) levels, and stable lesions. After the progression of LM, osimertinib at 160 mg daily further lengthened the quality of life and survival time of patients without any notable side effects during treatment. Recent related studies and our cases indicate that osimertinib has a positive effect on LM from EGFR-mutant NSCLC, regardless of T790M status. Keywords: non-small cell lung cancer, leptomeningeal metastases, osimertinib, EGFR mutation, T790M