双倍剂量埃克替尼治疗EGFR基因敏感突变肺腺癌柔脑膜转移疗效初探

Preliminary study on double-dose icotinib successfully treated leptomeningeal metastasis in lung adenocarcinoma patient with EGFR gene sensitive mutation

目的报告1例肺腺癌柔脑膜转移患者的诊断与治疗经过,探讨脑脊液基因检测对临床治疗的指导意义,以及双倍剂量埃克替尼治疗伴EGFR基因敏感突变的肺腺癌柔脑膜转移的疗效与安全性。方法与结果初诊女性肺腺癌柔脑膜转移患者,56岁。脑脊液及血液双标本基因检测显示,脑脊液EGFR基因外显子19缺失突变、血液标本呈阴性。予埃克替尼250 mg/次(3次/d)口服,每间隔8周复查胸部CT和头部增强MRI,肺部肿瘤灶呈渐进性缩小,柔脑膜强化程度减轻。通过右侧侧脑室-腹腔分流术降低颅内压、缓解症状与体征。截至2019年9月21日已治疗589天,病情稳定,主要药物不良反应为皮疹,仍继续服药并随访。结论对于肺腺癌柔脑膜转移患者,脑脊液基因检测EGFR基因敏感突变状态可指导临床制定治疗策略;双倍剂量埃克替尼治疗伴EGFR基因敏感突变的肺腺癌柔脑膜转移疗效确切,耐受性和安全性良好。

Objective To report the diagnosis and treatment of a patient with meningeal metastases from lung adenocarcinoma,and explore the significance of cerebrospinal fluid(CSF) gene detection for clinical treatment and the efficacy and safety of double-dose icotinib in the treatment of meningeal metastases from lung adenocarcinoma with EGFR gene sensitive mutation.Methods and Results A 56-year-old female patient with meningeal metastasis from lung adenocarcinoma was examined for CSF and blood double-sample genes.The CSF had an exon 19 deletion mutation in the EGFR gene,and no sensitive mutations were found in blood sample.Oral icotinib hydrochloride 250 mg/time(3 times/d),and chest CT and head MRI enhanced scans were re-examined every 8 weeks,suggesting that the lung tumor was significantly reduced,and the degree of jumbo meningeal enhancement was lessened than before.Right lateral ventricle-peritoneal shunt was performed to effectively reduce intracranila pressure(ICP) and relieve clinical symptoms.Up to September 21,2019,patient had been taking double doses of icotinib for 589 d,and her condition was stable.The main adverse drug reaction is rash.She is still taking medication and is being followed up.Conclusions For patients with meningeal metastases from lung adenocarcinoma,CSF gene detection of EGFR gene sensitive mutation can guide clinical development of treatment strategies.Double-dose icotinib is effective in treating meningeal metastases from lung adenocarcinoma with EGFR gene sensitive mutation,and is well tolerated and safe.