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Next-generation Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors for Leptomeningeal Carcinomatosis

Review of 2 Cases

Grimsrud, Kate W., MD; Mrugala, Maciej M., MD, PhD

doi: 10.1097/NRL.0000000000000220
Case Report/Case Series

Introduction: Epidermal growth factor receptor (EGFR) mutation status is strongly correlated with leptomeningeal carcinomatosis in non–small cell lung cancer. Historically, patients were treated with radiotherapy, intrathecal chemotherapy or first-generation EGFR tyrosine kinase inhibitors (TKIs); however, most would eventually develop resistance and disease progression. Therefore, recent interest has sparked in investigating next-generation EGFR-TKI monotherapy.

Case reports: We describe 2 patients with non–small cell lung adenocarcinoma who later presented with leptomeningeal disease, treated with next-generation EGFR-TKI monotherapy, independent of whole-brain radiotherapy, with favorable response and outcome.

Conclusions: The next-generation EGFR-TKIs may have improved success in treatment of leptomeningeal metastases in non–small cell lung adenocarcinoma when compared with the first-generation and second-generation EGFR-TKIs. Next-generation EGFR-TKI monotherapy should be considered in select patients with leptomeningeal metastases from lung adenocarcinoma. More research is needed to review this potential therapeutic option, especially for use as first-line therapy.

Department of Neurology, Mayo Clinic, Scottsdale, AZ

The authors declare no conflict of interest.

Correspondence to: Kate W. Grimsrud, MD, 13400 E. Shea Blvd., Scottsdale, AZ 85259. E-mail:

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