A patient of situs ambiguus with pancreatic head cancer successfully treated with gemcitabine and erlotinib

We report a case of a 66-year-old Taiwanese female patient with situs ambiguus diagnosed of pancreatic head cancer. She was treated with gemcitabine and erlotinib and remained in stable disease on follow-up imaging studies. Situs ambiguus is a rare disease and reports of such patients with cancer have rarely been reported in the literature. Our case illustrates that standard chemotherapy in this group of patients may be undergone with promising results.     

化疗联合恩度及厄洛替尼治疗1例 TKI 耐药肺腺癌患者

近年来随着新型低毒高效化疗药物和分子靶向药物的问世,晚期非小细胞肺癌（NSCLC）引入了根据组织学类型和基因突变治疗的新策略,其一是根据 EGFR 基因突变状态、ALK（间变淋巴瘤激酶融合基因）选择一线治疗,对此达成共识,策略其二当属晚期 NSCLC 维持治疗。但是 TKI（小分子酪氨酸激酶抑制剂）耐药是临床工作中面临的棘手问题,现对我们成功治疗1例 TKI 耐药晚期肺腺癌患者的治疗进行汇报。     

CT findings in non-small-cell lung cancer patients treated with gefitinib or erlotinib

Purpose: We performed this study to explore the association of computed tomography (CT) findings with outcomes of patients with non-small-cell lung cancer (NSCLC) treated with tyrosin kinase inhibitor (TKI) such as gefitinib or erlotinib. Materials and Methods: We analyzed outcomes for 240 patients according to primary tumor (T), regional nodal (N) staging and diffuse small pulmonary metastases (DSPM) at the initial presentation. Tests for epidermal growth factor receptor (EGFR) mutation were performed in 92 patients. Results: On multivariate analysis for tumor response, the N3 stage was predictive of a poor response (P < 0.001), whereas DSPM was a favorable factor (P = 0.007). Multivariate analysis for progression-free survival showed that the T3-4 stage (hazard ratio [HR]: 2.5, P < 0.001), in addition to the N3 stage (HR: 2.1, P < 0.001), was predictive of a poor outcome, whereas DSPM (HR: 0.6, P = 0.006) was a favorable factor. Notably, the multivariate model that included the EGFR mutational status revealed that the T3-4 stage predicted poor progression-free survival (HR: 2.2, P = 0.017) and poor overall survival (HR: 4.1, P < 0.001). Conclusion: Our data suggest that, in addition to EGFR mutational status, T-stage based on CT is predictive of outcomes of TKI-treated NSCLC patients.     

Use of erlotinib throughout pregnancy: a case-report of a patient with metastatic lung adenocarcinoma

The use of erlotinib throughout pregnancy has not been previously reported. We present the case of a 40 year-old female patient with stage IV lung adenocarcinoma, mediastinal, bone and cerebral metastasis, a EGFR mutation and no smoking history, who had begun first line treatment with erlotinib 150 mg once daily. After two and a half months of treatment a fourteen-week pregnancy was documented, and after informing on fetal risks secondary to erlotinib use and maternal risks secondary to treatment withholding, she decided to continue with treatment under clinical surveillance by both the oncology and obstetrics clinics. At thirty-three weeks gestation a live born 1600 g female was born by caesarean section without evidence of congenital malformations. Imaging assessment after eight months of treatment showed complete bone and central nervous system response and partial lung and mediastinal response. The patient is currently undergoing the 11th month of treatment and is asymptomatic, the baby is 4 months old and is in good health.     

Successful rechallenge with erlotinib in a patient with EGFR-mutant lung adenocarcinoma who developed gefitinib-related interstitial lung disease

Small-molecule tyrosine kinase inhibitors (TKIs) targeting the epidermal growth factor receptor (EGFR) pathways are used clinically for patients with non-small cell lung cancer (NSCLC). It is well established that somatic mutations in the kinase domain of the EGFR (Lynch et al. in N Engl J Med 350:2129–2139, 2004; Paez et al. in Science 304:1497–1500, 2004) are strongly associated with the tumor response and clinical outcomes in patients with NSCLC receiving EGFR-TKIs (Mitsudomi and Yatabe in Cancer Sci 98:1817–1824, 2007). Although the most common adverse events are skin rash and diarrhea, the most serious adverse effect reported is drug-related interstitial lung disease (ILD) (Inoue et al. in Lancet 361:137–139, 2003; Ando et al. in J Clin Oncol 24:2549–2556, 2006). The precise mechanism underlying the development of drug-related ILD remains unknown. Here, we describe a case of EGFR-mutant NSCLC who was rechallenged with the small-molecule EGFR antagonist erlotinib after developing gefitinib-related ILD.     

Biomarkers in tissue from patients with upper gastrointestinal cancers treated with erlotinib and bevacizumab

Malignancies in the upper gastrointestinal (UGI) tract are amongst the most aggressive cancers and only few treatment options exist. We have recently analysed data from a phase II trial where patients with UGI cancers were treated with erlotinib and bevacizumab. The combination therapy could not be recommended in an unselected population of patients with chemo-refractory UGI cancer. However, a subpopulation of patients did benefit from the therapy. In this prospectively planned biomarker study we investigated vascular endothelial growth factor A (VEGF-A), VEGF receptor 2 (VEGFR-2) and epidermal growth factor receptor (EGFR) by immunohistochemistry and KRAS mutation status detected by PCR as potential predictors of effect of therapy. High VEGF-A expression was correlated to longer overall survival (HR: 0.8, 95%CI: 0.7-0.9) and high VEGFR-2 expression to shorter progression free survival (HR: 1.4, 95%CI: 1.0-1.9). EGFR expression and KRAS mutation status were not correlated to response or survival. We conclude that VEGF-A and VEGFR-2 could potentially be predictive markers in patients with UGI cancers treated with erlotinib and bevacizumab.     

Radiation recall dermatitis in a patient treated with dacarbazine

Radiation recall describes an inflammatory reaction at a previously irradiated site associated with the use of chemotherapeutic agents. Dacarbazine, a tetrazine cytotoxic drug, has not been noted to cause this phenomenon. We report the case history of a 44-year-old female patient who developed a recall dermatitis due to dacarbazine in a site previously irradiated for the treatment of malignant melanoma. The skin erythema responded quickly to oral corticosteroid treatment. Further cycles of dacarbazine were facilitated with oral corticosteroid premedication. We conclude that dacarbazine should be considered as a potential cause of radiation recall dermatitis and that this can be managed and prevented with oral corticosteroids.     

Severe pulmonary toxicity in a patient treated with gemcitabine

Gemcitabine is a pyrimidine analog of deoxycytidine with activity against nonhematologic and hematologic malignancies. Its pulmonary toxicity is usually mild and self-limiting. We describe a male patient with lung cancer in whom severe dyspnea and interstitial infiltrates developed after the administration of gemcitabine.     

Carcinomatous meningitis in a post-operative patient with lung adenocarcinoma for which erlotinib was effective - a case report

A 53-year-old female was admitted to our hospital complaining of disturbance of consciousness and hallucinations. About one year and 5 months ago she had adenocarcinoma of the lung, which was treated with surgery and chemotherapy. Computed tomography and magnetic resonance imaging revealed that her lung cancer had relapsed as caricinomatous meningitis and multiple lung metastases. She was treated with erlotinib, which rapidly resulted in disappearance of her symptoms. She still continues to receive erlotinib therapy without suffering from evident relapse 7 months after the initiation of the treatment.     

Successful empirical erlotinib treatment of a mechanically ventilated patient newly diagnosed with metastatic lung adenocarcinoma

Background

Lung cancer is the most common solid tumor in critically ill cancer patients who are admitted to intensive care units (ICUs). An ICU trial consists of unlimited ICU support for a limited time period.

Case report

We present the case of a 60-year-old woman with newly diagnosed metastatic lung adenocarcinoma who required mechanical ventilation due to respiratory failure. Empirical erlotinib treatment was administered through a nasogastric feeding tube as part of an ICU trial, which led to a dramatic and durable response.

Conclusion

Empirical erlotinib should be considered when epidermal growth factor receptor (EGFR) mutations are suspected in ICU newly diagnosed patients with lung adenocarcinoma.     

A case of choroidal metastasis of lung cancer successfully treated with erlotinib

We present a case of choroidal metastasis of lung cancer in which choroidal metastasis, the first manifestation of recurrence, was successfully treated with erlotinib. A 49-year-old woman with a 2. 0 cm nodule in the right lung was diagnosed with adenocarcinoma, and a right upper lobectomy was performed. After 2 months, she presented with blurred vision of the right eye. Her right visual acuity had decreased to 0. 1, and there was a visual field defect temporal to the macula. Fundus examination of the right eye revealed an elevated mass with exudative retinal detachment temporal to the disc. Fluorescein angiography revealed hypofluorescence during the prearterial and arteriovenous phases, and fluorescein leakage surrounded by a circular hypofluorescence area during the venous phase. Spectral-domain optical coherence tomography showed exudative retinal detachment. The cancer cells had a mutation of the epidermal growth factor receptor gene in exon 19. She was treated with erlotinib at 100 mg per day, and after 4 days, her right visual acuity had improved to 1. 2.     

Safety of erlotinib treatment in outpatients with previously treated non-small-cell lung cancer in Japan

Purpose  

Erlotinib is the first epidermal growth factor receptor–tyrosine kinase inhibitor shown to provide a survival benefit for advanced non-small-cell lung cancer (NSCLC) patients. Adverse drug reactions of erlotinib in Japanese, which may be very different from those in Caucasians because of differences in genetic background, have not been fully reported. Therefore, we aimed to clarify the safety profile of erlotinib.