Zusammenfassung
Hintergrund
Die Wirksamkeit einer Erstlinientherapie mit Tyrosinkinaseinhibitoren auf den Primärtumor bei Patienten mit nicht kleinzelligem Bronchialkarzinom im Stadium IV und Nachweis einer EGF-Rezeptor-Mutation ist belegt. Demgegenüber existieren nur wenige Daten zur Wirksamkeit bei zerebraler Metastasierung.
Fallbericht und Ergebnisse
Bei einer 43-jährigen Patientin war die Diagnose eines hepatisch und zerebral metastasierten nicht-kleinzelligen Bronchialkarzinoms gestellt worden. Nach initialer Notfallbestrahlung aufgrund einer oberen Einflussstauung und einmaliger Gabe von Carboplatin erhielt die Patientin bei positivem Nachweis des mutierten EGF-Rezeptorgens parallel zur Bestrahlung des Primärtumors und der zervikalen Lymphknotenmetastasen Gefitinib in einer Dosierung von 250 mg/Tag. Nach kurzer Zeit war klinisch eine Besserung und radiologisch eine Teilremission nachweisbar. Hinsichtlich der zuvor nicht bestrahlten zerebralen Metastasen war 6 Wochen nach Behandlungsbeginn bildgebend eine Vollremission erreicht worden. Gravierende Toxizitäten traten nicht auf.
Schlussfolgerung
Der Verlauf lässt darauf schließen, dass Gefitinib ohne wesentlich erhöhte Toxizität parallel zur Bestrahlung eingesetzt werden kann. Darüber hinaus können unter alleiniger Therapie mit dem Tyrosinkinaseinhibitor Vollremissionen zerebraler Metastasen erreicht werden.
Abstract
Background
While the activity of tyrosine kinase inhibitors as the first line treatment for primary tumors in patients with stage IV non-small cell lung cancer and a positive EGF receptor mutation is well known, little data on the efficacy in controlling cerebral metastases are available.
Case Report and Results
A 43-year-old woman was diagnosed with non-small cell lung cancer with cerebral and hepatic metastases. Emergency radiation therapy was initiated at the time of diagnosis due to superior vena cava syndrome. However, after she failed to respond to this therapy and in light of a positive EGF receptor mutation, gefitinib was added at a dose of 250 mg/day while continuing radiation to the primary lesion and cervical lymph nodes. She showed a rapid clinical and radiologic response with complete remission of the cerebral metastases 6 weeks after starting gefitinib. No severe toxicity was observed.
Conclusion
This case demonstrates that gefitinib can be given during radiation treatment without significant toxicity. Furthermore, complete remission of cerebral metastases can be achieved with tyrosine kinase inhibitor monotherapy.
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Müller, F., Riesenberg, H., Hirnle, P. et al. Komplette Remission multifokaler zerebraler Metastasen bei chemotherapierefraktärem NSCLC durch Monotherapie mit Gefitinib. Strahlenther Onkol 187, 826–830 (2011). https://doi.org/10.1007/s00066-011-2260-4
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DOI: https://doi.org/10.1007/s00066-011-2260-4