Sustained response to standard dose osimertinib in a patient with plasma T790M‐positive leptomeningeal metastases from primary lung adenocarcinoma

A 44‐year‐old male, never smoker, suffers from stage IV adenocarcinoma of the right lung with epidermal growth factor receptor (EGFR) exon‐21 L858R point mutation on initial presentation. After 23 months of treatment with gefitinib, intercalated with multiple courses of radiotherapy, leptomeningeal...

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Bibliographic Details
Published in:Asia-Pacific journal of clinical oncology 2017-12, Vol.13 (6), p.428-430
Main Authors: Chan, Oscar Siu‐Hong, Leung, Warren Kam‐Wing, Yeung, Rebecca Mei‐Wan
Format: Article
Language:English
Subjects:
Acrylamides
Adenocarcinoma
Adenocarcinoma - drug therapy
Adenocarcinoma - pathology
Adenocarcinoma of Lung
Adult
Aniline Compounds
Antineoplastic Agents - pharmacology
Antineoplastic Agents - therapeutic use
circulating tumor DNA
Clinical trials
Cognition
Epidermal growth factor
Epidermal growth factor receptors
Gefitinib
Humans
leptomeningeal metastases
Lung cancer
Lung Neoplasms - drug therapy
Lung Neoplasms - pathology
Male
Meninges
Metastases
Metastasis
Mutation
osimertinib
Piperazines - pharmacology
Piperazines - therapeutic use
Point mutation
Polymerase chain reaction
Protein Kinase Inhibitors - therapeutic use
Radiation therapy
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Summary:A 44‐year‐old male, never smoker, suffers from stage IV adenocarcinoma of the right lung with epidermal growth factor receptor (EGFR) exon‐21 L858R point mutation on initial presentation. After 23 months of treatment with gefitinib, intercalated with multiple courses of radiotherapy, leptomeningeal metastases (LMs) developed. Acquired T790M mutation was confirmed by the droplet digital polymerase chain reaction plasma EGFR test. After switching to osimertinib at the standard dose, his neurocognitive function improved clinically, coupled with sustained radiological improvement. As this clinical entity is underrepresented in clinical trials, the practicability of plasma EGFR testing and the optimal dose–response relationship of osimertinib in T790M‐positive lung cancer complicated with LM deserves further exploration.
ISSN:1743-7555
1743-7563
DOI:10.1111/ajco.12673