RESUMEN
A 60-year-old man was admitted to our hospital because of the radiologic findings of meningeal carcinomatosis after long-term disease control of epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer, with cisplatin-based chemotherapy followed by gefitinib. Brain magnetic resonance imaging (MRI) revealed diffuse and linear enhancement on the surface of the midbrain and along the cerebellar folia. In addition, analysis of his cerebrospinal fluid (CSF) showed an increased WBC count and an elevated level of CEA. He presented no symptoms at the time of diagnosis of meningeal carcinomatosis; however, within 2 weeks, neurological symptoms such as disorientation, dysarthria, and ataxic gait became apparent. Since his symptoms seemed to worsen even under further treatment with different cisplatin-based chemotherapy or retreatment with gefitinib, we decided to initiate erlotinib treatment. His symptoms rapidly improved within a week of beginning treatment with erlotinib, and MRI and CSF examinations also showed remarkable improvement of the meningeal carcinomatosis. This case suggests that erlotinib may be effective in some patients with meningeal carcinomatosis previously treated with gefitinib. However, further studies are required to understand the differential efficacy of these drugs.
Asunto(s)
Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/secundario , Neoplasias Pulmonares/patología , Carcinomatosis Meníngea/tratamiento farmacológico , Carcinomatosis Meníngea/secundario , Inhibidores de Proteínas Quinasas/uso terapéutico , Quinazolinas/uso terapéutico , Clorhidrato de Erlotinib , Gefitinib , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia del TratamientoRESUMEN
We report one Japanese familial line in which there were three pulmonary MAC patients and one suspected patient over two generations, most of whom were diagnosed with the nodular/bronchiectatic type. In all patients, life circumstances and bacterial strains differed at the time of diagnosis. This suggests that the genes thought to affect patient susceptibility to pulmonary MAC disease may be involved in this family line. Comprehensive genotypic analysis of the CFTR gene, HLA typing, and analysis of the NRAMP1 polymorphisms were performed in seven members of this family. The results suggest that female sex and menopause might be associated with onset of pulmonary MAC of the nodular/bronchiectatic type, and HLA-A26 antigen and diabetes mellitus might be involved in disease exacerbations.