VP分流术后奥希替尼治疗EGFR L858R突变且吉非替尼耐药后T790M阴性肺癌脑膜转移多学科诊疗

Multidisciplinary diagnosis and treatment of lung cancer with leptomeningeal metastasis with T790M negative and EGFR L858R mutation and Gefitinib-resistant with Osimitinib treatment after VP shunt surgery

肺癌脑膜转移预后差, 表皮生长因子受体(EGFR)突变阳性使用1代酪氨酸激酶抑制剂耐药后T790M阴性的患者, 指南推荐化疗+抗血管生成治疗。本文中的EGFR L858R突变吉非替尼(易瑞沙)耐药T790M阴性的肺癌脑膜转移患者, 因高龄且既往化疗后胃肠道反应明显而拒绝化疗。根据影像科、神经外科、放疗科及肿瘤科多学科会诊讨论意见, 脑室腹腔分流术后使用奥希替尼, 患者最佳疗效达到疾病稳定, 脑膜转移后总生存时间已超过3年。

Lung cancer with Leptomeningeal metastasis has a poor prognosis,and for epidermal growth factor receptor(EGFR)mutation-positive patients with T790M negative after first-generation tyrosine kinase inhibitors resistance,guidelines recommend chemotherapy combined with anti-angiogenesis therapy.This article presented a female patient with EGFR L858R mutation and Iressa-resistant T790M negative leptomeningeal metastasis of lung cancer,who refused chemotherapy because of senior and could not tolerate the gastrointestinal reaction of chemotherapy.According to the multidisciplinary consultation and discussion opinions of the adiologist,neurosurgeon,radiotherapist and medical oncologist,the best curative effect of Osimertinib followed ventriculoperitoneal shunt was disease stability,and the overall survival time after diagnosis of leptomeningeal metastasis was more than 3 years.