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leptomeningeal carcinomatosis nsclc

Alvin J X Lee, Rachel Benamore, Monika Hofer, Meenali Chitnis
A 60-year-old male was diagnosed with T3, N3, M1b epidermal growth factor receptor (EGFR) mutant lung adenocarcinoma. Five months later he developed significant headaches, weakness and numbness of the left leg, and unsteadiness of gait. Magnetic resonance imaging (MRI) brain demonstrated subtle gyral enhancement indicative of early leptomeningeal infiltration. He was commenced on second-line erlotinib which improved his lower limb symptoms. Three months later he developed increased urinary frequency and redeveloped leg symptoms...
September 2016: Oxford Medical Case Reports
Elizabeth Dudnik, Shlomit Yust-Katz, Hovav Nechushtan, Daniel A Goldstein, Alona Zer, Dov Flex, Tali Siegal, Nir Peled
Central nervous system (CNS) metastases occur in 30% of patients with advanced non-small cell lung cancer (NSCLC). Localized treatments targeting CNS metastases result in delays in systemic therapy administration and are associated with neurocognitive impairment. Nivolumab is an immune check-point inhibitor that is approved as a second-line treatment of NSCLC. Data regarding the intracranial activity of nivolumab is lacking. We retrospectively reviewed the efficacy and safety of nivolumab in five patients with advanced NSCLC and new/progressing intracranial metastases...
August 2016: Lung Cancer: Journal of the International Association for the Study of Lung Cancer
Yurday Ozdemir, Berna Akkus Yildirim, Erkan Topkan
To assess the efficacy of whole-brain radiotherapy (WBRT) and prognostic factors in leptomeningeal carcinomatosis (LMC) of non-small-cell lung cancer (NSCLC) patients. WBRT records of 51 LMC patients confined to brain were reviewed. Eligible patients had squamous-cell carcinoma (SCC) or adenocarcinoma, and Eastern Cooperative Oncology Group Performance Status (ECOG PS) 0-3. The WBRT was either 20 or 30 Gray. The primary and secondary objectives were to determine overall survival (OS) and prognostic factors for improved treatment response, respectively...
September 2016: Journal of Neuro-oncology
Justin F Gainor, Andrew S Chi, Jennifer Logan, Ranliang Hu, Kevin S Oh, Priscilla K Brastianos, Helen A Shih, Alice T Shaw
The central nervous system (CNS) is an important and increasingly recognized site of treatment failure in anaplastic lymphoma kinase (ALK)-positive, non-small cell lung cancer (NSCLC) patients receiving ALK inhibitors. In this report, we describe two ALK-positive patients who experienced initial improvements in CNS metastases on standard dose alectinib (600 mg twice daily), but who subsequently experienced recurrences with symptomatic leptomeningeal metastases. Both patients were dose-escalated to alectinib 900 mg twice daily, resulting in repeat clinical and radiographic responses...
February 2016: Journal of Thoracic Oncology
Hidehiro Takei, Emilie Rouah, Yusuke Ishida
Metastases are the most common brain tumors especially in adults. Although they are generally considered a single disease entity which is universally fatal in patients with advanced cancer, brain metastases are remarkably heterogeneous both clinically and pathologically. As members of the multidisciplinary clinical team for the diagnosis and management of metastatic brain tumors, pathologists must be familiar not only with clinicopathologic features of brain metastases but also with any characteristic and clinically significant molecular findings...
January 2016: Brain Tumor Pathology
Bin-Chi Liao, Jih-Hsiang Lee, Chia-Chi Lin, Ya-Fang Chen, Chin-Hao Chang, Chao-Chi Ho, Jin-Yuan Shih, Chong-Jen Yu, James Chih-Hsin Yang
BACKGROUND: Leptomeningeal carcinomatosis (LC) is a detrimental complication of patients with non-small-cell lung cancer (NSCLC). The effect of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) on the clinical outcome of these patients, particularly those with EGFR mutations, has not been studied yet. METHODS: We searched the database for lung cancer patients diagnosed from 2003 to 2010 in one Asian medical center. NSCLC patients who also had LC diagnosed by either cytology or brain neuroimaging studies were identified...
December 2015: Journal of Thoracic Oncology
Lei Gong, Ming Xiong, Zhiyu Huang, Lulu Miao, Yun Fan
BACKGROUND: The incidence of leptomeningeal carcinomatosis (LMC) has increased in patients with metastatic non-small cell lung cancer (NSCLC). This study aimed to evaluate the effect of icotinib in the treatment of LMC. METHODS: Twenty-one NSCLC patients diagnosed with LMC and treated with icotinib were retrospectively reviewed. RESULTS: An exon 21 point mutation and an exon 19 deletion of EGFR were found in 10 and 11 patients, respectively...
September 2015: Lung Cancer: Journal of the International Association for the Study of Lung Cancer
Takahisa Kawamura, Akito Hata, Jumpei Takeshita, Shiro Fujita, Michio Hayashi, Keisuke Tomii, Nobuyuki Katakami
BACKGROUND: After initial response to epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKIs), approximately one-third of patients develop central nervous system (CNS) metastases, including leptomeningeal metastases (LM). To achieve longer survival, control of CNS metastases is important, but therapeutic options are limited for LM after failure of standard-dose EGFR-TKIs. METHODS: We retrospectively evaluated the efficacy and safety of high-dose erlotinib in EGFR-mutant non-small cell lung cancer (NSCLC) patients with refractory LM after failure of standard-dose EGFR-TKIs...
June 2015: Cancer Chemotherapy and Pharmacology
Sai-Hong Ignatius Ou, Karen R Sommers, Michele C Azada, Edward B Garon
No abstract text is available yet for this article.
February 2015: Oncologist
Chou-Han Lin, Ming-Tzer Lin, Yao-Wen Kuo, Chao-Chi Ho
We report a patient with non-small cell lung cancer (NSCLC) developed leptomeningeal carcinomatosis (LMC) after 4 years of multiple treatments. High-dose tyrosine kinase inhibitor (TKI) was given for LMC at first but was not effective. She then received dual therapy combining of afatinib and cetuximab. Brain magnetic resonance imaging (MRI) showed a partial response of disease and the patient experienced a clinical benefit. Our case suggests that dual targeting of epidermal growth factor receptor (EGFR) by a combination of afatinib and cetuximab can be a potential novel treatment option in treating LMC when high-dose TKI failed...
September 2014: Lung Cancer: Journal of the International Association for the Study of Lung Cancer
Jonathan W Riess, Seema Nagpal, Michael Iv, Michael Zeineh, Matthew A Gubens, Kavitha Ramchandran, Joel W Neal, Heather A Wakelee
INTRODUCTION: Leptomeningeal carcinomatosis (LM) is a severe complication of non-small-cell lung cancer (NSCLC) historically associated with poor prognosis. New chemotherapeutic and targeted treatments could potentially affect the natural history of LM. PATIENTS AND METHODS: Patients with a pathologic diagnosis of NSCLC with LM treated at Stanford between 2003 and 2011 were identified via institutional databases and medical records. LM was defined by cerebrospinal fluid (CSF) that was positive for malignant cells or by LM enhancement on magnetic resonance imaging with gadolinium contrast...
May 2014: Clinical Lung Cancer
Justin F Gainor, Sai-Hong Ignatius Ou, Jennifer Logan, Lawrence F Borges, Alice T Shaw
Anaplastic lymphoma kinase (ALK) gene rearrangements define a distinct molecular subset of non-small-cell lung cancer that is highly responsive to treatment with the ALK inhibitor crizotinib. Recently, it has been recognized that the brain is a frequent site of relapse among ALK-positive patients treated with crizotinib. In this report, we expand on these observations and present a series of ALK-positive patients with two distinct forms of metastatic, central nervous system involvement: intramedullary spinal cord metastasis and leptomeningeal carcinomatosis...
December 2013: Journal of Thoracic Oncology
Eunyoung Lee, Bhumsuk Keam, Dong-Wan Kim, Tae Min Kim, Se-Hoon Lee, Doo Hyun Chung, Dae Seog Heo
INTRODUCTION: Leptomeningeal carcinomatosis (LMC) from non-small-cell lung cancer (NSCLC) is a clinically important neurological complication in the era of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs). The purpose of this study was to compare the efficacy of gefitinib and erlotinib for control of LMC in NSCLC. METHODS: We retrospectively reviewed medical records of 25 EGFR TKI-treated NSCLC patients with LMC between 2004 and 2012 at Seoul National University Hospital...
August 2013: Journal of Thoracic Oncology
Jonathan W Riess, Seema Nagpal, Joel W Neal, Heather A Wakelee
Leptomeningeal carcinomatosis (LM) is an infrequent yet morbid and often fatal complication of non-small cell lung cancer (NSCLC). Management of LM is multimodal, often involving systemic chemotherapy, radiotherapy, and a variety of symptom management maneuvers to address elevated intracranial pressure, pain, and mood changes that can accompany the disease. It is increasingly recognized that tumors with actionable mutations in NSCLC, including epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) translocations, respond well to systemic therapy with tyrosine kinase inhibitors yet often progress in the central nervous system...
April 1, 2013: Journal of the National Comprehensive Cancer Network: JNCCN
Ho-Shin Gwak, Jungnam Joo, Sohee Kim, Heon Yoo, Sang Hoon Shin, Ji-Youn Han, Heung Tae Kim, Jin Soo Lee, Seung Hoon Lee
INTRODUCTION: : Reports on the treatment result of leptomeningeal carcinomatosis (LMC) from a single primary cancer are rare and mixed treatment modalities make it even more difficult to interpret the results properly. Here, we report clinical outcomes of an intraventricular chemotherapy for LMC from non-small-cell lung cancer. METHODS: : Medical records of 105 patients were retrieved and retrospectively analyzed to find the prognostic factors of patients' survival and symptom responses, including intracranial pressure (ICP) control...
May 2013: Journal of Thoracic Oncology
J L Kuiper, E F Smit
A considerable number of patients with epidermal growth factor receptor (EGFR)-mutated non-small-cell lung cancer (NSCLC) develop leptomeningeal metastases. Leptomeningeal metastases are associated with deterioration of clinical symptoms and poor survival. Traditionally, treatment of metastases in the central nervous system consists of radiotherapy and less frequently, surgery. The role of systemic therapy is limited due to the blood-brain barrier inhibiting pharmacological doses to be reached in the central nervous system...
April 2013: Lung Cancer: Journal of the International Association for the Study of Lung Cancer
Su Jin Lee, Jung-Il Lee, Do-Hyun Nam, Young Chan Ahn, Jung Ho Han, Jong-Mu Sun, Jin Seok Ahn, Keunchil Park, Myung-Ju Ahn
BACKGROUND: The incidence of leptomeningeal carcinomatosis (LC) has increased in patients with metastatic non-small-cell lung cancer (NSCLC) because of recent improvements in survival. The clinical features and prognostic factors of LC in NSCLC patients, however, have not been well identified. The aim of this study was to identify the clinical features and prognostic factors of NSCLC patients with LC. METHODS: One hundred and forty-nine consecutive NSCLC patients with cytologically proven LC diagnoses between 2001 and 2009 at Samsung Medical Center were retrospectively reviewed...
February 2013: Journal of Thoracic Oncology
Ying Yuan, Chunwen Tan, Modan Li, Hong Shen, Xuefeng Fang, Yinghong Hu, Shenglin Ma
About 20% to 40% of patients with non-small cell lung cancer (NSCLC) will develop brain metastases during the natural course of their disease. The prognosis for such patients is very poor with limited survival. In addition to the standard whole brain radiation therapy (WBRT), some studies have shown that chemotherapy drugs and/or epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI) can improve the outcome of these patients. Here, we report a stage IIIA patient who developed multiple brain metastases one year after operation...
2012: World Journal of Surgical Oncology
Hee Kyung Ahn, Boram Han, Su Jin Lee, Taekyu Lim, Jong-Mu Sun, Jin Seok Ahn, Myung-Ju Ahn, Keunchil Park
Anaplastic lymphoma kinase (ALK) inhibitor has shown dramatic efficacy in non-small cell lung cancer (NSCLC) patients harboring ALK rearrangements in phase I trial. Herein we report two cases of NSCLC patients with leptomeningeal carcinomatosis (LM), treated with ALK inhibitor under emergent use of investigational new drug combined with intrathecal methotrexate treatment. Progression free survival was 10 months and 6 months, respectively, and little additional toxicities were observed. These results suggest that ALK inhibitor might be safely administered even in patients or those with metastases in central nervous system...
May 2012: Lung Cancer: Journal of the International Association for the Study of Lung Cancer
Takako Okyuama, Yuki Akazawa, Junji Uchida, Kazumi Nishino, Toru Kumagai, Fumio Imamura
Erlotinib (Tarceva) is a selective small-molecule inhibitor of HER1/EGFR tyrosine kinases that is especially effective for treating non-small cell lung cancer (NSCLC) harboring a constitutively active EGFR mutation. Erlotinib treatment frequently induces adverse effects such as skin rashes and diarrhea, but severe toxicity is rare. Whereas interstitial pneumonia induced by erlotinib is sometimes observed, toxicity in the central nerve system (CNS) is rarely reported. Here, we report a 75-year-old female NSCLC patient who developed subacute encephalopathy during erlotinib treatment...
2011: Oncology Research
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