A surgical intervention followed by adjuvant treatment of erlotinib for a 85-year-old elderly advanced lung cancer

Abstract

A 85-year-old female with two lesions in left upper lobe (S¹⁺²: 4.7 cm and S³: 1.5 cm) was diagnosed with pulmonary adenocarcinoma. Preoperatively, a mutation analysis of epidermal growth factor receptor (EGFR) gene resulted in negative one. A computed tomographic scan pointed out a contralateral small nodule (right S⁸: 1 cm) with bilateral multicentric ground glass opacities. Even though a very-elderly but a healthy IV-staged advanced lung cancer, she desired for receiving a multimodality therapy. Left upper lobectomy with mediastinal nodal dissection was preceded. Eventually, the postoperative pathology disclosed lung cancer with multiple pulmonary metastasis in the contralateral lobe (T3N2M1a, stage IV). An another detection method of EGFR gene mutation revealed a positive result of the resected specimen. A first-line adjuvant oral administration of erlotinib treatment had diminished the unresected multicentric lesions, which stable status have been maintained for more than 12 months. The first-line erlotinib therapy showed a dramatic response for the elderly patient with EGFR gene mutation-positive. A reliability and accuracy of the detection method should be important to select an appropriate treatment. In clinical practice of the selected population of advanced lung cancer with EGFR mutation-positive, combination therapy of aggressive surgical resection and erlotinib therapy might take advantage of extending the progression-free survival, in case of her no enough time in the rest life because of her very-elderly age.