Case: EGFR mutation (+) NSCLC c CNS only progression

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Presentation transcript:

Case: EGFR mutation (+) NSCLC c CNS only progression Ho Jung An St. Vincent’s hospital The catholic University of korea suwon, korea

pemetrexed baseline (2016.3.8) f/u (2016.6.10) Comparison with previous MRI (2016-04-23), 1. Interval somewhat decreased sulcal hyperintensities of both temporal-occipital lobes in FLAIR images. ; possible somewhat improvement of leptomeningeal metastasis 2. Tiny nodular enhancements in left thalamus, right pons, right posterior temporal cortex, ; parenchymal metastasis. 3. Chemotherapy related white matter changes in both periventricular white matter, without interval change. New brain parenchymal metastases

#1. NSCLCa, LUL (adeno, cT3N3M1b) c pleural, liver, LN, bone meta EGFR exon 21 point mutation Gefitinib start (2015.6.4~2016.3.11) 2015.7 Leptomeningeal metastasis c IICP CSF drainage & intrathecal methotrexate (2015.7.23~11.26) Whole brain radiotherapy (2016.1.27~2.12): 3000cGy/10fx pemetrexed (2016.3.12~ 1. Interval slightly increased sulcal hyperintensity in FLAIR with leptomeningeal enhancement in both occipital and temporal lobes. ; interval slightly increased leptomeningeal metastasis. 2. Chemotherapy related white matter changes in both periventricular white matter, without interval change.

#1. NSCLCa, LUL (adeno, cT3N3M1b) c pleural, liver, LN, bone meta Summary & Questions #1. NSCLCa, LUL (adeno, cT3N3M1b) c pleural, liver, LN, bone meta EGFR exon 21 point mutation Gefitinib (2015.6.4~2016.3.11) 2015.7 Leptomeningeal metastasis c IICP CSF drainage & intrathecal methotrexate (2015.7.23~11.26) Whole brain radiotherapy (2016.1.27~2.12): 3000cGy/10fx pemetrexed (2016.3.12~5.17) What would be the next therapeutic option? - rebiopsy? - Where? Lung? Liquid biopsy? - BBB penetrating cytotoxic chemotherapy - higher dose of gefitinib or 2nd/3rd generation EGFR TKI