内容紹介
A Case of Lung Adenocarcinoma with Coexisting G719X and T790M EGFR Mutations in Which Erlotinib Was Effective for the Treatment of Leptomeningeal Carcinomatosis
Summary
A 68-year-old man was referred to our hospital because of an abnormal chest shadow. Adenocarcinoma was detected using percutaneous needle aspiration cytology from the left supraclavicular lymph node. The patient was diagnosed as having primary adenocarcinoma of the lung(cT1bN3M1b: BRA OSS). Exon 18 G719X and exon 20 T790M mutations of the EGFR gene were detected in the same specimen. For first-line chemotherapy, four courses of cisplatin plus docetaxel were used. The primary lesion and a brain metastasis were reduced after the first-line chemotherapy. About four months later, he developed a recurrent brain metastasis and leptomeningeal carcinomatosis. He was treated with erlotinib(150 mg/day)after whole-brain irradiation. The leptomeningeal carcinomatosis findings on a head CT image and the patient's consciousness disorder improved after treatment. EGFR-TKI therapy was effective in a case with leptomeningeal carcinomatosis, and coexisting EGFRsensitive and EGFR-resistant mutations.
要旨
症例は68歳,男性。胸部異常陰影にて当院を紹介受診。左鎖骨上窩リンパ節への経皮的針吸引細胞診で腺癌を検出し,原発性肺腺癌(cT1bN3M1b: BRA OSS)と診断した。同検体での上皮成長因子受容体(EGFR)遺伝子変異検査でexon 18 G719Xおよびexon 20 T790M変異を認めた。初回治療としてシスプラチン+ドセタキセル併用療法を4コース施行し,原発巣および多発脳転移巣の縮小が得られた。約4か月後に脳転移巣の増悪と髄膜癌腫症を併発,全脳照射後にエルロチニブ(150 mg/日)の投与を開始したところ,髄膜癌腫症について画像所見や意識障害などの軽快が得られた。診断時よりEGFR感受性,耐性遺伝子を同時に有する髄膜癌腫症に対して上皮成長因子受容体チロシンキナーゼ阻害薬(EGFR-TKI)は有効であると考えられた。
目次
Summary
A 68-year-old man was referred to our hospital because of an abnormal chest shadow. Adenocarcinoma was detected using percutaneous needle aspiration cytology from the left supraclavicular lymph node. The patient was diagnosed as having primary adenocarcinoma of the lung(cT1bN3M1b: BRA OSS). Exon 18 G719X and exon 20 T790M mutations of the EGFR gene were detected in the same specimen. For first-line chemotherapy, four courses of cisplatin plus docetaxel were used. The primary lesion and a brain metastasis were reduced after the first-line chemotherapy. About four months later, he developed a recurrent brain metastasis and leptomeningeal carcinomatosis. He was treated with erlotinib(150 mg/day)after whole-brain irradiation. The leptomeningeal carcinomatosis findings on a head CT image and the patient's consciousness disorder improved after treatment. EGFR-TKI therapy was effective in a case with leptomeningeal carcinomatosis, and coexisting EGFRsensitive and EGFR-resistant mutations.
要旨
症例は68歳,男性。胸部異常陰影にて当院を紹介受診。左鎖骨上窩リンパ節への経皮的針吸引細胞診で腺癌を検出し,原発性肺腺癌(cT1bN3M1b: BRA OSS)と診断した。同検体での上皮成長因子受容体(EGFR)遺伝子変異検査でexon 18 G719Xおよびexon 20 T790M変異を認めた。初回治療としてシスプラチン+ドセタキセル併用療法を4コース施行し,原発巣および多発脳転移巣の縮小が得られた。約4か月後に脳転移巣の増悪と髄膜癌腫症を併発,全脳照射後にエルロチニブ(150 mg/日)の投与を開始したところ,髄膜癌腫症について画像所見や意識障害などの軽快が得られた。診断時よりEGFR感受性,耐性遺伝子を同時に有する髄膜癌腫症に対して上皮成長因子受容体チロシンキナーゼ阻害薬(EGFR-TKI)は有効であると考えられた。