Choong Nicholas W, Dietrich Sascha, Seiwert Tanguy Y, Tretiakova Maria S, Nallasura Vidya, Davies Gareth C, Lipkowitz Stanley, Husain Aliya N, Salgia Ravi, Ma Patrick C
Section of Hematology-Oncology, University of Chicago, Chicago, IL, USA.
Nat Clin Pract Oncol. 2006 Jan;3(1):50-7; quiz 1 p following 57. doi: 10.1038/ncponc0400.
A 70-year-old Japanese-American woman who had never smoked was diagnosed with stage IV non-small-cell lung cancer with rib metastases. She had previously been well and she had no family history of malignancy. While receiving treatment with erlotinib, an epidermal growth factor receptor small-molecule inhibitor, she progressed and developed new brain metastases. She failed further chemotherapy treatments and subsequently developed extensive symptomatic leptomeningeal carcinomatosis associated with diplopia, hemiparesis, weight loss, and incontinence.
Chest X-ray, head and chest CT scan, R2 lymph-node biopsy, histopathology, immunohistochemistry, MRI of head and spine, lumbar puncture, laser microdissection and EGFR genomic DNA sequencing of the R2 lymph node and cerebrospinal fluid tumor cells.
Erlotinib-refractory stage IV lung adenocarcinoma and end-stage symptomatic leptomeningeal metastases with a novel double L858R + E884K somatic mutation of the EGFR.
Carboplatin, paclitaxel and erlotinib, whole-brain radiotherapy, temozolomide with and without irinotecan, and gefitinib.
一名70岁从未吸烟的日裔美国女性被诊断为IV期非小细胞肺癌伴肋骨转移。她之前身体状况良好，且无恶性肿瘤家族史。在接受表皮生长因子受体小分子抑制剂厄洛替尼治疗期间，病情进展并出现新的脑转移。她对进一步的化疗治疗无效，随后发展为广泛的有症状软脑膜癌病，伴有复视、偏瘫、体重减轻和尿失禁。
胸部X光、头部和胸部CT扫描、R2淋巴结活检、组织病理学、免疫组织化学、头部和脊柱MRI、腰椎穿刺、R2淋巴结和脑脊液肿瘤细胞的激光显微切割及表皮生长因子受体基因组DNA测序。
厄洛替尼难治性IV期肺腺癌及终末期有症状软脑膜转移，伴有表皮生长因子受体新的双重L858R + E884K体细胞突变。
卡铂、紫杉醇和厄洛替尼、全脑放疗、替莫唑胺（联合或不联合伊立替康）以及吉非替尼。
