Kawaguchi Yo, Hanaoka Jun, Hayashi Hideki, Mizusaki Naoki, Iihara Hirotoshi, Itoh Yoshinori, Sugiyama Tadashi
Division of General Thoracic Surgery, Department of Surgery, Shiga University of Medical Science, Otsu City, Japan.
Chemotherapy. 2017;62(3):147-150. doi: 10.1159/000454727. Epub 2016 Dec 29.
Leptomeningeal metastases occur in 1% of patients with non-small-cell lung cancer. There have been several reports on the treatment of leptomeningeal metastases with afatinib. Our patient was a 41-year-old woman who had never smoked and was diagnosed with stage IV adenocarcinoma of the lung with an epidermal growth factor receptor (EGFR) mutation. She was treated with afatinib for the recurrence of leptomeningeal metastases. After the treatment with afatinib was initiated, the neurological symptoms dramatically regressed, and she achieved progression-free survival for 7 months. The concentration of afatinib in the cerebrospinal fluid (CSF) ranged from 0.05 to 0.14 ng/mL, and the penetration rate of afatinib from the plasma to the CSF ranged from 0.28 to 0.40%. This concentration might be sufficient to achieve a clinical effect for leptomeningeal carcinomatosis. Therefore, afatinib administered at the usual doses may be an effective treatment for leptomeningeal carcinomatosis of EGFR-mutated or EGFR-tyrosine kinase inhibitor-sensitive lung adenocarcinoma.
软脑膜转移发生于1%的非小细胞肺癌患者中。关于阿法替尼治疗软脑膜转移已有多篇报道。我们的患者是一名41岁从未吸烟的女性，被诊断为伴有表皮生长因子受体（EGFR）突变的IV期肺腺癌。她接受了阿法替尼治疗软脑膜转移复发。开始使用阿法替尼治疗后，神经症状显著消退，她实现了7个月的无进展生存。脑脊液（CSF）中阿法替尼的浓度为0.05至0.14 ng/mL，阿法替尼从血浆到脑脊液的渗透率为0.28至0.40%。该浓度可能足以对软脑膜癌病产生临床效果。因此，以常规剂量给药的阿法替尼可能是治疗EGFR突变或对EGFR酪氨酸激酶抑制剂敏感的肺腺癌软脑膜癌病的有效疗法。
