Abstract
Osimertinib has demonstrated efficacy against stable or asymptomatic central nervous system (CNS) metastases of epidermal growth factor receptor (EGFR) mutation-positive non-small-cell lung cancer (NSCLC) in phase 2 and 3 clinical trials that allowed prior CNS radiotherapy. However, the efficacy of osimertinib only or the optimal treatment combination or sequence of radiotherapy has not been investigated. A 74-year-old woman diagnosed with T4N1M1c Stage IVB lung adenocarcinoma with EGFR mutation presented with a left upper lobe mass and multiple bilateral lung metastases. A total of more than 20 asymptomatic multiple brain metastases with a maximum diameter of 12 mm were diagnosed simultaneously. Osimertinib was administered as first-line treatment. Whole brain radiotherapy was deferred because she had no neurological symptoms. After 5 weeks, the multiple brain metastases disappeared completely, together with the response in the lung lesions. This case demonstrated that first-line treatment with osimertinib could even achieve complete remission of multiple brain metastases comprising as many as twenty lesions of EGFR-mutated NSCLC without radiation therapy. Radiation therapy for brain metastases can be deferred or even withheld. A new treatment strategy for EGFR mutated NSCLC with CNS metastases should be investigated using osimertinib, especially regarding optimal combination or sequence of radiotherapy.
Highlights
Brain metastasis often occurs as a serious complication in non-small-cell lung cancer (NSCLC) patients and leads to a deterioration in the quality of life (QOL) and reduced overall survival (OS) [1]
We report the first single case that described complete remission of multiple brain metastatic lesions of epidermal growth factor receptor (EGFR)-mutated NSCLC treated with first-line osimertinib without radiotherapy
Osimertinib can result in complete remission of multiple brain metastasis in patients with as many as twenty EGFRmutated NSCLC lesions without radiation therapy when used as first-line treatment
Summary
Brain metastasis often occurs as a serious complication in non-small-cell lung cancer (NSCLC) patients and leads to a deterioration in the quality of life (QOL) and reduced overall survival (OS) [1]. The efficacy of first-generation EGFR-TKIs against CNS metastatic lesions of EGFR-mutated NSCLC has been shown in several small phase 2 trials [3,4,5]. This is attributable to their ability to cross the blood-brain barrier (BBB) probably due to their low molecular weight [6]. In the preplanned subgroup analysis, osimertinib showed robust systemic and intracranial efficacy against EGFR-mutated NSCLC patients with CNS metastases in both the untreated population and the population with acquired T790M resistance mutation after prior EGFR-TKI treatment [13,14,15]. We report the first single case that described complete remission of multiple brain metastatic lesions of EGFR-mutated NSCLC treated with first-line osimertinib without radiotherapy
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