Brain metastasis effectively treated with erlotinib following the acquisition of resistance to gefitinib: a case report

Abstract

IntroductionNon-small-cell lung cancer harboring an activated epidermal growth factor receptor mutation exhibits a good response to epidermal growth factor receptor-tyrosine kinase inhibitors; however, clinicians often experience treatment failure following the development of resistance to epidermal growth factor receptor-tyrosine kinase inhibitor.Case presentationWe here report a case of a 56-year-old Japanese woman with non-small-cell lung carcinoma with a secondary T790M mutation associated with resistance to epidermal growth factor receptor-tyrosine kinase inhibitor that maintained sensitivity of brain metastases to epidermal growth factor receptor-tyrosine kinase inhibitor. An autopsy showed that the primary focus had a T790M mutation; however, no mutations of T790M were found in the brain metastases.ConclusionThis case demonstrates the detection of T790M was associated with the clinical responsiveness to epidermal growth factor receptor-tyrosine kinase inhibitor.

Osimertinib is associated with improved outcomes in pre-treated non-small cell lung cancer leptomeningeal metastases: A systematic review and meta-analysis

“…Following the initial screening process, which involved removing ineligible articles and supplementing with studies from authors’ files, a total of 128 publications were ultimately included in the meta-analysis ( Appendix B and Appendix C ). 106 of the publications were case reports [ [14] , [15] , [16] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] , [80] , [81] , [82] , [83] , [84] , [85] , [86] , [87] , [88] , [89] , [90] , [91] , [92] , [93] , [94] , [95] , [96] , [97] , [98] , …”

Leptomeningeal metastases from non-small cell lung cancer: state of the art and recent advances

“…Nanjo et al [43] described that acquired resistance to gefitinib is characterized by an upregulation of MET and absence of T790M mutation. Moreover, the T790M mutation has not been identified neither in BM or LM [44,45] , nor in CSF of patients who have developed LM following EGFR TKIs [46] . Jiang et al [47] reported a lower frequency of T790M mutation (21%) and a higher frequency of MET amplification (39%) in the CSF, suggesting that MET amplification could confer a major risk of leptomeningeal invasion [48] .…”

A Neuro-oncologist’s Perspective on Management of Brain Metastases in Patients with EGFR Mutant Non-small Cell Lung Cancer

“…But, there are also retrospective studies of patients with active CNS disease, both of brain metastases and leptomeningeal disease, who progressed on prior treatments with erlotinib or gefitinib but had intracranial response to afatinib [50]. Additionally, there have been reports of patients responding to erlotinib even after development of the T790M [51, 52]. We utilized pulse dosing for isolated CNS progression, as there is evidence that T790M mutations are less common in BrM during pharmacokinetic failure than in systemic disease [51].…”