Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2020; 8(2): 370-376
Published online Jan 26, 2020. doi: 10.12998/wjcc.v8.i2.370
Durable response to pulsatile icotinib for central nervous system metastases from EGFR-mutated non-small cell lung cancer: A case report
Hui-Ying Li, Yu Xie, Ting-Ting Yu, Yong-Juan Lin, Zhen-Yu Yin
Hui-Ying Li, Yu Xie, Ting-Ting Yu, Yong-Juan Lin, Zhen-Yu Yin, Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
Author contributions: Yin ZY designed the report; Xie Y, Yu TT, and Lin YJ collected the patient’s clinical data; Li HY analyzed the data and wrote the paper; Yin ZY revised the manuscript; all authors have read and approve the final manuscript.
Supported by the Key Project of Nanjing Health Bureau, No. ZKX16031; the Healthcare Project of Nanjing Science and Technology Committee, No. 201715020; the Medical Key Science and Technology Development Project of Nanjing, No. ZKX18014; the Cadre Health Care Project of Jiangsu Province, No. BJ18006; and the Cancer Research Funding of CSCO-Hausen, No. Y-HS2019-5.
Informed consent statement: Written informed consent was obtained from the patient and his next-of-kin regarding the publication of the case details and associated images.
Conflict-of-interest statement: The author reports no conflicts of interest in this work.
CARE Checklist (2016) statement: The manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhen-Yu Yin, PhD, Attending Doctor, Department of Geriatric Oncology, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, No. 321, Zhongshan Road, Nanjing 210008, Jiangsu Province, China. lihuiying@njglyy.com
Received: October 11, 2019
Peer-review started: October 11, 2019
First decision: December 4, 2019
Revised: December 6, 2019
Accepted: December 22, 2019
Article in press: December 22, 2019
Published online: January 26, 2020
Abstract
BACKGROUND

Central nervous system (CNS) metastases are a catastrophic complication of non-small cell lung cancer (NSCLC), including brain and leptomeningeal carcinomatosis, and are always accompanied by a poor prognosis. Despite the continuous development of existing treatments, the therapy of CNS metastases remains challenging.

CASE SUMMARY

We report a patient who was definitively diagnosed with brain and leptomeningeal metastases from NSCLC with a targeted mutation in epidermal growth factor receptor (EGFR). A standard dosage of icotinib (125 mg three times daily) was implemented but ineffective. CNS lesions developed despite stable systemic control, so pulsatile icotinib (1125 mg every 3 d) was administered. This new strategy for administration has lasted 25 mo so far, and resulted in complete remission of neurological symptoms, almost vanished lesions, and longer survival with no notable side effects.

CONCLUSION

This is the first successful example of pulsatile icotinib for treating isolated CNS progression from EGFR mutation-positive NSCLC, providing a new alternative for the local treatment of CNS metastases.

Keywords: Non-small cell lung cancer, Central nervous system metastases, EGFR mutation, Pulsatile icotinib, Case report

Core tip: Central nervous system (CNS) metastases are a catastrophic complication of non-small cell lung cancer (NSCLC) and always accompanied by a poor prognosis. We report a patient who was diagnosed with CNS metastases from NSCLC with a targeted mutation in epidermal growth factor receptor. A standard dosage of icotinib (125 mg three times daily) was implemented but ineffective. So pulsatile icotinib (1125 mg every 3 d) was administered. This new strategy for administration resulted in complete remission of neurological symptoms, almost vanished lesions, and longer survival without notable side effects, providing a new alternative for the treatment of CNS metastases.