Kunimasa Kei, Yoshioka Hiroshige, Iwasaku Masahiro, Nishiyama Akihiro, Ubukata Satoshi, Ishida Tadashi
Department of Respiratory Medicine, Kurashiki Central Hospital.
Nihon Kokyuki Gakkai Zasshi. 2010 Feb;48(2):166-71.
We report two cases of central nervous system metastases from non-small cell lung cancer in patients being administered gefitinib, which improved after changing treatment to erlotinib. Case 1: A 57-year-old man developed carcinomatous meningitis while receiving third-line treatment with gefitinib after surgery for lung cancer. His symptoms markedly improved upon changing treatment to erlotinib. Case 2: A 54-year-old woman developed multiple brain metastases during third-line treatment with gefitinib. After changing her treatment to erlotinib, enhanced head MRI showed that the size of brain lesions had decreased. At the recommended dosage, erlotinib showed higher blood concentrations than gefitinib, and may also have been higher in cerebral spinal fluid. This may explain the difference in efficacy between gefitinib and erlotinib in central nervous system metastases.
我们报告了两例非小细胞肺癌中枢神经系统转移患者在接受吉非替尼治疗时出现病情进展，而换用厄洛替尼治疗后病情改善的病例。病例1：一名57岁男性在肺癌手术后接受吉非替尼三线治疗时发生癌性脑膜炎。换用厄洛替尼治疗后，其症状明显改善。病例2：一名54岁女性在接受吉非替尼三线治疗时发生多发脑转移。换用厄洛替尼治疗后，头颅增强MRI显示脑病灶大小减小。在推荐剂量下，厄洛替尼的血药浓度高于吉非替尼，在脑脊液中的浓度可能也更高。这可能解释了吉非替尼和厄洛替尼在中枢神经系统转移治疗中疗效差异的原因。
