[Diagnosis and Treatment of Leptomeningeal Metastasis in Non-small Cell Lung Cancer]

Effective Treatment With Afatinib of Lung Adenocarcinoma With Leptomeningeal Metastasis Harboring the Exon 18 p.G719A Mutation in the EGFR Gene Was Detected in Cerebrospinal Fluid: A Case Report

Background: In patients with lung adenocarcinoma and leptomeningeal metastases, it remains unknown whether non-classical mutations in the epidermal growth factor receptor (EGFR) gene can be detected in the cerebrospinal fluid (CSF) and how it may be used to design directed therapy.

Methods: On April 18, 2018, the Interventional Department of Tianjin Huanhu Hospital admitted a 34-years-old male patient with lung adenocarcinoma and leptomeningeal metastasis. An emergency lateral ventriculoperitoneal shunt was performed to relieve the clinical symptoms of intracranial hypertension. Next-generation sequencing (NGS) of the CFS specimens revealed a mutation in EGFR exon 18 p.G719A, and afatinib was administered. Follow-up showed significantly relieved headache, with significantly reduced soft leptomeningeal abnormal enhancement as revealed by enhanced magnetic resonance imaging and significantly smaller tumors in the left lung by chest computed tomography. Carcinoembryonic antigens (CEAs) in cerebrospinal fluid and peripheral blood were significantly reduced. The patient responded well to afatinib, with mild adverse complications. The patient died on October 27, 2019 from respiratory failure as a result of lung infection unrelated to cancer progression. The overall survival (OS) using afatinib was 530 days.

Conclusion: CSF can be used as a liquid biopsy for NGS gene detection in patients with lung adenocarcinoma and leptomeningeal metastases. Afatinib exhibits a beneficial effect in patients with lung adenocarcinoma and leptomeningeal metastases harboring the EGFR exon 18 p.G719A mutation.

[Analysis of Clinicopathological Feature and Prognosis for Leptomeningeal Metastasis in Non-small Cell Lung Cancer]

背景与目的

脑膜转移(leptomeningeal metastasis, LM)是晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)严重并发症之一, 生活质量降低, 预后差。本研究旨在探讨NSCLC-LM患者的临床病理特征及预后。

方法

回顾性分析2015年1月-2016年6月首都医科大学附属北京朝阳医院收治的3例NSCLC-LM患者的临床资料, 并结合文献进行分析。

结果

3例患者均为肺腺癌, 且表皮生长因子受体(epidermal growth factor receptor, EGFR)21外显子L858R突变(mutations, m), 其中男性1例, 女性2例; 年龄59岁-64岁, 平均年龄61.3岁, 主要临床表现及查体:头痛(3/3)、头晕(3/3)、恶心呕吐(3/3)、癫痫(2/3)、复视(1/3)、听力下降(1/3)、脑膜刺激征(3/3)。出现症状到LM确诊时间为1个月-4个月(平均2.3个月)。除了1例肺癌和LM同时诊断, 2例分别在EGFR酪氨酸激酶抑制剂(tyrosine kinase inhibitors, TKIs)和化疗进展后出现LM, 肺癌到LM平均确诊时间为8.5个月。3例患者脑增强磁共振成像(magnetic resonance imaging, MRI)均显示软脑膜线性强化; 3例脑脊液中找到癌细胞, 其中2例行EGFR检测, 均为EGFR 21外显子L858R突变。2例患者接受TKIs治疗, 症状好转, 其中1例联合替莫唑胺, 无进展生存期(progression-free survival, PFS)达4.9个月, 总生存时间(overall survival, OS)为13.9个月。

结论

EGFRm肺腺癌可能易出现LM; NSCLC-LM症状不典型, 易漏诊、误诊; TKIs联合替莫唑胺可能是EGFRm-NSCLC-LM的治疗选择。