Li Hui-Ying, Xie Yu, Yu Ting-Ting, Lin Yong-Juan, Yin Zhen-Yu
Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China.
World J Clin Cases. 2020 Jan 26;8(2):370-376. doi: 10.12998/wjcc.v8.i2.370.
Central nervous system (CNS) metastases are a catastrophic complication of non-small cell lung cancer (NSCLC), including brain and leptomeningeal carcinomatosis, and are always accompanied by a poor prognosis. Despite the continuous development of existing treatments, the therapy of CNS metastases remains challenging.
We report a patient who was definitively diagnosed with brain and leptomeningeal metastases from NSCLC with a targeted mutation in epidermal growth factor receptor (). A standard dosage of icotinib (125 mg three times daily) was implemented but ineffective. CNS lesions developed despite stable systemic control, so pulsatile icotinib (1125 mg every 3 d) was administered. This new strategy for administration has lasted 25 mo so far, and resulted in complete remission of neurological symptoms, almost vanished lesions, and longer survival with no notable side effects.
This is the first successful example of pulsatile icotinib for treating isolated CNS progression from mutation-positive NSCLC, providing a new alternative for the local treatment of CNS metastases.
中枢神经系统（CNS）转移是非小细胞肺癌（NSCLC）的灾难性并发症，包括脑转移和软脑膜癌病，且预后通常较差。尽管现有治疗方法不断发展，但CNS转移的治疗仍然具有挑战性。
我们报告了一名患者，该患者被明确诊断为NSCLC伴脑和软脑膜转移，且表皮生长因子受体（）存在靶向突变。给予标准剂量的埃克替尼（每日3次，每次125mg）治疗，但无效。尽管全身病情得到稳定控制，但CNS病变仍有进展，因此给予脉冲式埃克替尼治疗（每3天1125mg）。这种新的给药策略至今已持续25个月，导致神经症状完全缓解，病灶几乎消失，生存期延长，且无明显副作用。
这是脉冲式埃克替尼治疗 突变阳性NSCLC孤立性CNS进展的首个成功案例，为CNS转移的局部治疗提供了新的选择。
