Multimodality treatment approach in a patient with EGFR-mutated NSCLC and leptomeningeal metastases: A case report and literature review.

RATIONALE

Leptomeningeal metastases in pulmonary adenocarcinoma patients carrying epidermal growth factor receptor mutations present a critical therapeutic dilemma. However, there is no established standard therapy following drug resistance. Novel treatment modalities are urgently needed.

PATIENT CONCERNS

We report a 62-year-old nonsmoking man who presented with multiple bilateral pulmonary nodules and underwent left lower lobectomy in October 2012.

DIAGNOSIS

Pathological examination confirmed poorly differentiated adenocarcinoma with neuroendocrine differentiation, classified as clinical stage IV.

INTERVENTIONS

The patient was initially treated with oral osimertinib; however, resistance developed after 6 months. Genetic analysis revealed an epidermal growth factor receptor exon 21 mutation. After a comprehensive treatment plan that included targeted therapy, radiotherapy, chemotherapy, and concurrent therapies. The patient achieved a total survival time of 28 months following the diagnosis of leptomeningeal metastases.

OUTCOMES

The multimodality treatment method described in this case, incorporating whole-brain radiotherapy, intrathecal chemotherapy (dose escalation), and concurrent therapies, prolonged the patient's survival.

LESSONS

Integrating a multimodal treatment plan that includes whole-brain radiotherapy and intrathecal administration of pemetrexed disodium could offer a promising treatment option for lung cancer patients with leptomeningeal metastasis.