Gefitinib is effective for pathological fracture of metastatic non-small cell lung cancer

  • Manabu Hoshi
  • Masatsugu Takami
  • Makoto Ieguchi
  • Kunio Takaoka
Case Report


We present a 67-year-old woman with advanced-stage lung adenocarcinoma (T2N3M1, Stage IV). Palliative surgery with an intramedullary nail was performed for the sudden onset of a pathological fracture of the right proximal femur. Gefitinib, an epidermal growth factor receptor tyrosine kinase inhibitor, administration without radiotherapy for 3 months led to remarkable recovery of the mineralization in the metastatic femoral lesion, in accordance with size reduction of the primary lung tumor. Her serum CEA level markedly decreased. She has remained alive during follow-up for 22 months after the surgery, and has suffered no adverse effects of gefitinib administration other than a skin rash and mild diarrhea. Oral gefitinib administration had an excellent effect on bone repair and mineralization for a pathological fracture of metastatic lung adenocarcinoma.


Pathological fracture Lung cancer Gefitinib Bone metastasis 


Conflict of interest statement



  1. 1.
    Jemal A, Siegel R, Ward E, Murray T et al (2007) Cancer statistics 2007. CA Cancer J Clin 57:43–66PubMedCrossRefGoogle Scholar
  2. 2.
    Katagiri H, Takahashi M, Wakai K et al (2005) Prognostic factors and a scoring system for patients with skeletal metastasis. J Bone Joint Surg Br 87:698–703PubMedCrossRefGoogle Scholar
  3. 3.
    Nottebaert M, Exner GU, von Hochstetter AR et al (1989) Metastatic bone disease from occult carcinoma: a profile. Int Orthop 13:119–123PubMedCrossRefGoogle Scholar
  4. 4.
    Fukuoka M, Yano S, Giaccone G et al (2003) Multi-institutional randomized phase II trial of gefitinib for previously treated patients with advanced non-small-cell lung cancer. J Clin Oncol 21:2237–2246PubMedCrossRefGoogle Scholar
  5. 5.
    Lee DH, Han JY, Lee HG et al (2005) Gefitinib as a first-line therapy of advanced or metastatic adenocarcinoma of the lung in never-smokers. Clin Cancer Res 11:3032–3037PubMedCrossRefGoogle Scholar
  6. 6.
    Inoue A, Saijo Y, Maemondo M et al (2003) Severe acute interstitial pneumonia and gefitinib. Lancet 361:137–139PubMedCrossRefGoogle Scholar
  7. 7.
    Stemmler HJ, Weigert O, Krych M et al (2005) Brain metastases in metastatic non-small cell lung cancer responding to single-agent gefitinib: a case report. Anticancer Drugs 16:747–749PubMedCrossRefGoogle Scholar
  8. 8.
    Roggero E, Busi G, Palumbo A et al (2005) A Gefitinib (‘Iressa’, ZD1839) is active against brain metastases in a 77 year old patient. J Neurooncol 71:277–280PubMedCrossRefGoogle Scholar
  9. 9.
    Nishi N, Kawai S, Yonezawa T et al (2006) Effect of gefitinib on brain metastases from non-small cell lung cancer. Neurol Med Chir 46:504–507CrossRefGoogle Scholar
  10. 10.
    Ishida A, Kanoh K, Nishisaka T et al (2004) Gefitinib as a first line of therapy in non-small cell lung cancer with brain metastases. Intern Med 43:718–720PubMedCrossRefGoogle Scholar
  11. 11.
    Yokouchi H, Yamazaki K, Kinoshita I et al (2007) Clinical benefit of readministration of gefitinib for initial gefitinib-responders with non-small cell lung cancer. BMC Cancer 20:51CrossRefGoogle Scholar
  12. 12.
    Lange T, Muller-Tidow C, Serve H et al (2005) First-line systemic treatment with gefitinib in stage IV non-small cell lung cancer. Oncol Rep 14:1539–1542PubMedGoogle Scholar
  13. 13.
    Charoentum C (2006) Thai female non-smoker with recurrent lung adenocarcinoma who has dramatic and prolonged response to gefitinib for over one year. J Med Assoc Thai 89:882–886PubMedGoogle Scholar
  14. 14.
    Hayashi M, Sekikawa A, Saijo A et al (2005) Successful treatment of hypertrophic osteoarthropathy by gefitinib in a case with lung adenocarcinoma. Anticancer Res 25:2435–2438PubMedGoogle Scholar
  15. 15.
    Gridelli C, Maione P, Galetta D et al (2007) Three cases of long-lasting tumor control with erlotinib after progression with gefitinib in advanced non-small cell lung cancer. J Thorac Oncol 2:758–761PubMedCrossRefGoogle Scholar
  16. 16.
    Garfield D (2006) Increasing osteoblastic lesions as a manifestation of a major response to gefitinib. J Thorac Oncol 1:859–860PubMedCrossRefGoogle Scholar
  17. 17.
    Saad F, Lipton A, Cook R et al (2007) Pathologic fractures correlate with reduced survival in patients with malignant bone disease. Cancer 110:1860–1867PubMedCrossRefGoogle Scholar
  18. 18.
    Angelucci A, Gravina GL, Rucci N et al (2006) Suppression of EGF-R signaling reduces the incidence of prostate cancer metastasis in nude mice. Endocr Relat Cancer 13:197–210PubMedCrossRefGoogle Scholar
  19. 19.
    Normanno N, Gullick WJ (2006) Epidermal growth factor receptor tyrosine kinase inhibitors and bone metastases: different mechanisms of action for a novel therapeutic application? Endocr Relat Cancer 13:3–6PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Manabu Hoshi
    • 1
  • Masatsugu Takami
    • 2
  • Makoto Ieguchi
    • 1
  • Kunio Takaoka
    • 1
  1. 1.Department of Orthopedic SurgeryOsaka City University Graduate School of MedicineAbeno-KuJapan
  2. 2.Department of Orthopedic SurgeryYodogawa Christian HospitalHigashi-yodogawa-kuJapan

Personalised recommendations