Deparment of Oncology, First Affiliated Hospital, Jilin University, Changchun, Jilin, PR China.
Medicine (Baltimore). 2021 Jul 30;100(30):e26680. doi: 10.1097/MD.0000000000026680.
Approximately 20% of patients with non-small cell lung cancer (NSCLC) are diagnosed with brain metastasis, which is related to poor survival outcomes. The ability of tyrosine kinase inhibitor drugs to penetrate the blood-brain barrier makes them a potential option for intracranial metastases. Dacomitinib, an irreversible second-generation pan-HER tyrosine kinase inhibitor, has become a standard therapy for patients with epidermal growth factor receptor mutations. However, its efficacy in patients with brain metastases (BMs) is not yet established. Here, we present 2 patients with epidermal growth factor receptor-mutant NSCLC with brain metastasis. After initiation of dacomitinib as first-line treatment, a significant clinical response was achieved, and a long-lasting complete remission was achieved in 1 patient up to this date.
Case 1 was a 47-year-old man who was admittedtothe hospital because of recurrent cough and expectoration for >1 year. Chest computed tomography scans revealed a high-density shadow in the left upper lobe. Cranial magnetic resonance imaging indicated an abnormal nodular enhancement in the right cerebellar hemisphere. Case 2 was a 55-year-old man with a chief complaint of intermittent cough and expectoration for >1 month. Chest computed tomography revealed a high-density mass in the left superior lobe. Magnetic resonance imaging of the central nervous system revealed 2 abnormal nodular enhancements in the left frontal lobe.
Both patients were diagnosed with lung adenocarcinoma by bronchoscopy and lymph node biopsy.
Both patients received dacomitinib 30 mg once daily as first-line therapy for 8 and 11 months, respectively until disease progression.
After treatment with dacomitinib, both patients achieved complete response in BMs. Progression-free survival was 11 and 8 months, respectively.
Dacomitinib strongly controlled BMs in patients with advanced NSCLC, and the adverse reactions were tolerable. Dacomitinib may be considered a new treatment option for these patients. Further prospective studies are recommended to confirm this conclusion.
约 20%的非小细胞肺癌（NSCLC）患者被诊断出患有脑转移，这与不良的生存结果有关。由于酪氨酸激酶抑制剂药物能够穿透血脑屏障，因此它们成为颅内转移的潜在选择。达可替尼是一种不可逆的第二代泛 HER 酪氨酸激酶抑制剂，已成为表皮生长因子受体突变患者的标准治疗方法。然而，其在脑转移（BMs）患者中的疗效尚未确定。在这里，我们报告了 2 例患有表皮生长因子受体突变的 NSCLC 伴脑转移的患者。在开始使用达可替尼作为一线治疗后，1 例患者获得了显著的临床反应，并且截至目前该患者仍处于持久的完全缓解状态。
病例 1 为 47 岁男性，因反复咳嗽、咳痰 1 年余入院。胸部 CT 扫描显示左肺上叶高密度影。头颅磁共振成像显示右小脑半球异常结节样增强。病例 2 为 55 岁男性，因间断咳嗽、咳痰 1 个月余就诊。胸部 CT 显示左肺上叶高密度肿块。中枢神经系统磁共振成像显示左额叶 2 个异常结节样增强。
支气管镜和淋巴结活检均诊断为肺腺癌。
2 例患者均接受达可替尼 30mg，每日 1 次作为一线治疗，分别治疗 8 个月和 11 个月后疾病进展。
达可替尼治疗后，2 例患者脑转移病灶均达到完全缓解。无进展生存期分别为 11 个月和 8 个月。
达可替尼对晚期 NSCLC 患者的脑转移灶具有较强的控制作用，不良反应可耐受。达可替尼可能是这类患者的一种新的治疗选择。建议进一步开展前瞻性研究以证实这一结论。
