Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :1360
Small font sizeDefault font sizeIncrease font size
Navigate here
  Search
 
  
Resource links
   Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
   Article in PDF (209 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   References

 Article Access Statistics
    Viewed307    
    Printed0    
    Emailed0    
    PDF Downloaded42    
    Comments [Add]    

Recommend this journal

 


 
  Table of Contents  
LETTER TO THE EDITOR
Year : 2016  |  Volume : 53  |  Issue : 3  |  Page : 365
 

Utility of driver mutation


Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India

Date of Web Publication24-Feb-2017

Correspondence Address:
K Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.200665

Rights and Permissions



How to cite this article:
Sharma V, Patil V, Noronha V, Joshi A, Prabhash K. Utility of driver mutation. Indian J Cancer 2016;53:365

How to cite this URL:
Sharma V, Patil V, Noronha V, Joshi A, Prabhash K. Utility of driver mutation. Indian J Cancer [serial online] 2016 [cited 2017 May 1];53:365. Available from: http://www.indianjcancer.com/text.asp?2016/53/3/365/200665


Sir,

We highlight a patient of epidermal growth factor receptor (EGFR) mutant adenocarcinoma lung with solitary brain metastasis who relapsed early after curative treatment but had prolonged disease control on gefitinib.

A 43-year-old male, presented in June 2011 with headache for 2 months and recent episode of altered sensorium. Magnetic resonance imaging brain revealed single right frontal lobe enhancing lesion 2.4 cm × 1.8 cm. The lesion was excised. Histopathology revealed metastatic adenocarcinoma. The postoperative positron emission tomography scan revealed single fluorodeoxyglucose avid right upper lobe lung lesion 2.2 cm × 1.7 cm and no distant metastasis. He underwent the right upper lobectomy. Histopathology showed adenocarcinoma, EGFR exon 19-1 deletion, pT 2.5 cm × 1 cm, all cut margins negative, pN 0/27 (pT1N0M1b). Subsequently, the patient remained in follow-up.

In December 2011, after a disease-free interval (DFI) of 5 months, he had tumor recurrence in the brain-right frontal lobe and left cerebellar hemisphere. Contrast enhanced computed tomography thorax showed no lung lesion. He received whole brain radiotherapy (WBRT) 25 gray in ten fractions and remained in follow-up.

In October 2012, after a DFI of 10 months, he developed malignant pleural effusion. Tablet gefitinib 250 mg OD was started. In September 2013, after a progression-free interval of 11 months, the disease progressed in brain (frontal lobe and leptomeningeal enhancement), new subdural metastases at the dorsal cord, and multiple bony metastases. He was planned WBRT 25 gray in ten fractions. After four fractions of radiotherapy, he developed increasing drowsiness, quadriparesis and ultimately succumbed to aspiration pneumonia.

In selected patients, surgical removal of brain metastases can prolong survival. Two randomized trials by Patchell et al.[1] and Vecht et al.[2] demonstrated a significant survival benefit in patients treated with surgery plus WBRT compared to WBRT alone. Surgical excision should be considered for patients with good performance status, minimal or no evidence of extracranial disease, and a surgically accessible single brain metastasis amenable to complete excision.

EGFR mutation status has prognostic implications in nonsmall cell lung cancer (NSCLC) patients who develop brain metastases. Porta et al.[3] demonstrated the efficacy of erlotinib in this subgroup. Median time to progression in the brain in EGFR mutants and controls was 11.7 months and 5.8, months respectively (P < 0.05). Median overall survival was 12.1 months and 3.1 months, respectively (P < 0.001).

Park et al.[4] demonstrated the efficacy of gefitinib or erlotinib in EGFR mutant NSCLC with brain metastases. Eighty-three percent patients had partial response, and 11% had stable disease. Median progression-free survival and overall survival were 6.6 months and 15.9 months, respectively.

This case highlights that with appropriate treatment approach, prolonged overall survival can be achieved in patients of NSCLC with brain metastases.

Acknowledgments

We are grateful to the patient and his family members for cooperating in his treatment and providing us his medical records.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, et al. A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 1990;322:494-500.  Back to cited text no. 1
    
2.
Vecht CJ, Haaxma-Reiche H, Noordijk EM, Padberg GW, Voormolen JH, Hoekstra FH, et al. Treatment of single brain metastasis: Radiotherapy alone or combined with neurosurgery? Ann Neurol 1993;33:583-90.  Back to cited text no. 2
    
3.
Porta R, Sánchez-Torres JM, Paz-Ares L, Massutí B, Reguart N, Mayo C, et al. Brain metastases from lung cancer responding to erlotinib: The importance of EGFR mutation. Eur Respir J 2011;37:624-31.  Back to cited text no. 3
    
4.
Park SJ, Kim HT, Lee DH, Kim KP, Kim SW, Suh C, et al. Efficacy of epidermal growth factor receptor tyrosine kinase inhibitors for brain metastasis in non-small cell lung cancer patients harboring either exon 19 or 21 mutation. Lung Cancer 2012;77:556-60.  Back to cited text no. 4
    




 

Top
Print this article  Email this article
 

    

  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow