2016 Volume 56 Issue 4 Pages 290-296
Background. We report three cases of leptomeningeal carcinomatosis with lung adenocarcinoma who experienced responded favorably for both neurological symptoms and performance status (PS) following treatment with afatinib. Case 1. A woman in her 20s with stage IV lung adenocarcinoma with an Exon19 deletion of EGFR gene. The patient developed symptomatic leptomeningeal carcinomatosis during a previous chemotherapy session and was hospitalized with PS 4. She subsequently received afatinib as third-line therapy. Two weeks later, the neurological symptoms were relieved, her headache and nausea had disappeared, and the vomiting had stopped. The PS was dramatically improved when the patient was discharged. Case 2. A woman in her 40s with stage IV lung adenocarcinoma with an Exon19 deletion of EGFR gene. The patient developed symptomatic leptomeningeal carcinomatosis during a previous chemotherapy session and was hospitalized with PS 4. She subsequently received afatinib as third-line therapy. Two weeks later, the neurological symptoms were relieved, her consciousness was back to normal, her headache and nausea had disappeared, and the vomiting had stopped. The PS was dramatically improved when the patient was discharged. Case 3. A woman in her 60s with stage IV lung adenocarcinoma with an L858R Exon21 mutation of EGFR gene. The patient developed symptomatic leptomeningeal carcinomatosis and was hospitalized with PS 4. Tumor cells were suspected in the spinal fluid based on the cytology findings. She received afatinib as first-line therapy. Four weeks later, the neurological symptoms were relieved, her consciousness was back to normal (Japan Coma Scale: III-100→I-1), her headache and nausea had disappeared, and the vomiting had stopped. She is currently still receiving afatinib therapy and is alive 11 months later without disease progression. Conclusion. This is the first report on the effect of afatinib in leptomeningeal carcinomatosis in EGFR mutation-positive lung adenocarcinoma. The neurological symptoms were improved in all cases. The progression-free survival in Cases 1 and 2 after starting afatinib was 8 and 5 months, respectively, and the overall survival after starting afatinib was 19 and 8 months, respectively. Case 3 is still alive 11 months later without progression. These findings suggest that afatinib might improve the symptoms and quality of life of EGFR-mutant lung adenocarcinoma patients with leptomeningeal carcinomatosis.
