image: Figure 1: Treatment timeline with chest computed tomography (CT) and brain magnetic resonance images (MRI) on osimertinib. (A) Pretreatment CT chest, demonstrating 18 mm spiculated mass in the left upper lobe (LUL). (B) CT chest following 12 days of Osimertinib treatment, showing decreased size of LUL mass. (C) Pretreatment brain MRI showing no acute abnormalities (axial). (D) Pretreatment brain MRI showing no acute abnormalities (sagittal).
Credit: 2024 Bhatia et al.
“[...] this case supports a body of literature noting potentially dramatic clinical benefits of administering appropriate oncogene directed targeted therapy [...]”
BUFFALO, NY- January 24, 2024 – A new case report was published in Oncotarget's Volume 15 on January 16, 2024, entitled, “Lazarus effect in a patient initially empirically treated with osimertinib for EGFR L858R mutant non-small cell lung cancer with leptomeningeal disease: a case report.”
Osimertinib has been shown to be effective for patients with non-small cell lung cancer (NSCLC) with activating EGFR mutations. These patients are also at risk for leptomeningeal disease (LMD). LMD is characterized by central nervous system metastases with spread to the cerebrospinal fluid or leptomeninges. In patients with NSCLC with EGFR activating mutations, there is an increased occurrence of LMD, which occurs in 9% of patients.
In this new report, researchers Shreya Bhatia, Manuel G. Cortez, Spencer Lessans, and Wade T. Iams from Vanderbilt-Ingram Cancer Center present a patient of East Asian descent whose initial presentation included severe, progressive leptomeningeal carcinomatosis and a small lung mass, with limited tissue available for molecular testing. She responded to empiric, urgent initiation of osimertinib, repeat tissue sampling revealed an EGFR L858R mutation, and she has experienced durable disease improvement for 18 months on osimertinib monotherapy.
“Our case demonstrates the nuances of decision-making in starting osimertinib in urgent clinical settings. Given our patient’s progressively worsening functional status and spread of disease to her CNS upon presentation, there was a need to begin treatment imminently. Time constraints, financial constraints, and lack of sufficient tissue for analysis ultimately led to the empiric use of osimertinib. Through the urgent initiation of appropriate anti-cancer therapy, she experienced both a life saving improvement in functional status and improvement in her LUL primary tumor one month into treatment.”
Read the full paper: DOI: https://doi.org/10.18632/oncotarget.28550
Correspondence to: Wade T. Iams
Email: wade.t.iams@vumc.org
Keywords: EGFR mutation, leptomeningeal disease, non-small cell lung cancer, osimertinib
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Journal
Oncotarget
Method of Research
Case study
Subject of Research
People
Article Title
Lazarus effect in a patient initially empirically treated with osimertinib for EGFR L858R mutant non-small cell lung cancer with leptomeningeal disease: a case report
Article Publication Date
16-Jan-2024