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Remarkable Effect of Gefitinib Retreatment in a Lung Cancer Patient With Lepidic Predominat Adenocarcinoma who had Experienced Favorable Results From Initial Treatment With Gefitinib: A Case Report.

Lee SJ, Lee HS, Choi JS, Na JO, Seo KH, Oh MH, Jou SS - J Clin Med Res (2012)

Bottom Line: Gefitnib is an oral agent of epidermal growth factor receptor tyrosine kinase inhibitor, and it has a certain efficacy against non-small cell lung cancer.There are some reports that the non-small cell lung cancer patients who experienced disease progression after responding to gefitinib were again sensitive to re-administration of gefitinib following temporary cessation of gefitinib.This is the case report showing a remarkable effect of gefitinib re-treatment in a patient with metastatic invasive adenocarinoma who had experienced favorable results from the initial treatment with gefitinib.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal medicine, Collage of Medicine, Soonchunhyang University, Cheonan, Republic of Korea.

ABSTRACT
Gefitnib is an oral agent of epidermal growth factor receptor tyrosine kinase inhibitor, and it has a certain efficacy against non-small cell lung cancer. There are some reports that the non-small cell lung cancer patients who experienced disease progression after responding to gefitinib were again sensitive to re-administration of gefitinib following temporary cessation of gefitinib. This is the case report showing a remarkable effect of gefitinib re-treatment in a patient with metastatic invasive adenocarinoma who had experienced favorable results from the initial treatment with gefitinib.

No MeSH data available.


Related in: MedlinePlus

EGFR gene analysis.
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Figure 3: EGFR gene analysis.

Mentions: A 72-years-old nonsmoker woman with fever, chronic cough, purulent sputum, and dyspnea, who had previously taken medication for bronchial asthma for 16 years, was admitted because chest X-ray showed a 5 cm-sized mass-like consolidation in the right lower lung field. Chest computed tomography also noted pneumonic infiltrations in the middle lobe and right lower lobe of the right lung. We started intravenous antibiotics upon diagnosis as possible pneumonia. Bronchial washing was performed because we could not exclude malignancy, such as invasive adenocarcinoma. Washing cytology was negative for malignancy. Although symptoms were improved with antibiotics, a follow-up chest X-ray was not improved. Furthermore, chest CT scans after 4 months showed aggravated infiltrations and newly developed nodules in both of the upper lung fields (Fig. 1A). Percutaneous transthoracic needle aspiration was performed on the patient. Finally, lepidic predominant adenocarcinoma was diagnosed (Fig. 2). After this diagnosis, the patient received the three courses of first-line chemotherapy with docetaxel plus carboplatin as stage IV (T4N0M1) with lung-to-lung metastasis. However, the treatment response was progressive disease (Fig. 1B). Thus, the patient began to take gefitinib at 250 mg/day because EGFR gene analysis in this patient showed a deletion mutation in exon 19 and point mutation L858R in exon 21 by direct sequence method (Fig. 3). A remarkable tumor regression was found as nearly complete response was achieved after 2 months (Fig. 1C). The tumor size of right middle lobe and lower lobe was decreasing, and the metastatic nodules of both upper lobes had nearly disappeared. This response lasted for almost 15 months (Fig. 1D). Although gefitinib was discontinued because the disease had progressed, the patient with a good performance status received 2 courses of pemetrexed and 4 sequential courses of gemcitabine/vinorelbine chemotherapy (Fig. 4A, B). Despite continued chemotherapy, the patient showed radiographic progression. Thus, we commenced re-treatment with gefitinib. Two months later, a partial response had been achieved at the primary tumor and metastatic lesions (Fig. 4C). The response continued even after 4 months. Even after that, the repeated re-administration of gefitinib after 3 to 4 months had elapsed was shown stable disease. The patient was still alive 5 years after she was initially diagnosed with metastatic invasive adenocarcinoma.


Remarkable Effect of Gefitinib Retreatment in a Lung Cancer Patient With Lepidic Predominat Adenocarcinoma who had Experienced Favorable Results From Initial Treatment With Gefitinib: A Case Report.

Lee SJ, Lee HS, Choi JS, Na JO, Seo KH, Oh MH, Jou SS - J Clin Med Res (2012)

EGFR gene analysis.
© Copyright Policy - open access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3376882&req=5

Figure 3: EGFR gene analysis.
Mentions: A 72-years-old nonsmoker woman with fever, chronic cough, purulent sputum, and dyspnea, who had previously taken medication for bronchial asthma for 16 years, was admitted because chest X-ray showed a 5 cm-sized mass-like consolidation in the right lower lung field. Chest computed tomography also noted pneumonic infiltrations in the middle lobe and right lower lobe of the right lung. We started intravenous antibiotics upon diagnosis as possible pneumonia. Bronchial washing was performed because we could not exclude malignancy, such as invasive adenocarcinoma. Washing cytology was negative for malignancy. Although symptoms were improved with antibiotics, a follow-up chest X-ray was not improved. Furthermore, chest CT scans after 4 months showed aggravated infiltrations and newly developed nodules in both of the upper lung fields (Fig. 1A). Percutaneous transthoracic needle aspiration was performed on the patient. Finally, lepidic predominant adenocarcinoma was diagnosed (Fig. 2). After this diagnosis, the patient received the three courses of first-line chemotherapy with docetaxel plus carboplatin as stage IV (T4N0M1) with lung-to-lung metastasis. However, the treatment response was progressive disease (Fig. 1B). Thus, the patient began to take gefitinib at 250 mg/day because EGFR gene analysis in this patient showed a deletion mutation in exon 19 and point mutation L858R in exon 21 by direct sequence method (Fig. 3). A remarkable tumor regression was found as nearly complete response was achieved after 2 months (Fig. 1C). The tumor size of right middle lobe and lower lobe was decreasing, and the metastatic nodules of both upper lobes had nearly disappeared. This response lasted for almost 15 months (Fig. 1D). Although gefitinib was discontinued because the disease had progressed, the patient with a good performance status received 2 courses of pemetrexed and 4 sequential courses of gemcitabine/vinorelbine chemotherapy (Fig. 4A, B). Despite continued chemotherapy, the patient showed radiographic progression. Thus, we commenced re-treatment with gefitinib. Two months later, a partial response had been achieved at the primary tumor and metastatic lesions (Fig. 4C). The response continued even after 4 months. Even after that, the repeated re-administration of gefitinib after 3 to 4 months had elapsed was shown stable disease. The patient was still alive 5 years after she was initially diagnosed with metastatic invasive adenocarcinoma.

Bottom Line: Gefitnib is an oral agent of epidermal growth factor receptor tyrosine kinase inhibitor, and it has a certain efficacy against non-small cell lung cancer.There are some reports that the non-small cell lung cancer patients who experienced disease progression after responding to gefitinib were again sensitive to re-administration of gefitinib following temporary cessation of gefitinib.This is the case report showing a remarkable effect of gefitinib re-treatment in a patient with metastatic invasive adenocarinoma who had experienced favorable results from the initial treatment with gefitinib.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal medicine, Collage of Medicine, Soonchunhyang University, Cheonan, Republic of Korea.

ABSTRACT
Gefitnib is an oral agent of epidermal growth factor receptor tyrosine kinase inhibitor, and it has a certain efficacy against non-small cell lung cancer. There are some reports that the non-small cell lung cancer patients who experienced disease progression after responding to gefitinib were again sensitive to re-administration of gefitinib following temporary cessation of gefitinib. This is the case report showing a remarkable effect of gefitinib re-treatment in a patient with metastatic invasive adenocarinoma who had experienced favorable results from the initial treatment with gefitinib.

No MeSH data available.


Related in: MedlinePlus