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

2. pemetrexed baseline (2016.3.8) f/u (2016.6.10)
Comparison with previous MRI ( ), 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

3. #1. NSCLCa, LUL (adeno, cT3N3M1b) c pleural, liver, LN, bone meta
EGFR exon 21 point mutation
Gefitinib start ( ~ )
Leptomeningeal metastasis c IICP
CSF drainage & intrathecal methotrexate ( ~11.26)
Whole brain radiotherapy ( ~2.12): 3000cGy/10fx
pemetrexed ( ~
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.

4. #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 ( ~ )
Leptomeningeal metastasis c IICP
CSF drainage & intrathecal methotrexate ( ~11.26)
Whole brain radiotherapy ( ~2.12): 3000cGy/10fx
pemetrexed ( ~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