Successful therapy using high-dose furmonertinib for non-small cell lung cancer with leptomeningeal metastasis: a case report and literature review

Frontiers in Oncology

Oncology

Hai-jun Gou¹  Kai-jian Lei²  Yan-ling Shu²  Mao-yue Fu²  Yu-ming Jia²  Ting Chen²  Jie Chen²  De-sheng Liu³ 

[1] Department of Oncology, People’s Hospital of Junlian County, Yibin, Sichuan, China;Department of Oncology, Second People’s Hospital of Yibin, Yibin, Sichuan, China;Department of Thoracic and Cardiovascular Surgery, Second People’s Hospital of Yibin, Yibin, Sichuan, China;

关键词: NSCLC;    EGFR;    furmonertinib;    leptomeningeal metastasis;    target therapy;   

DOI  :  10.3389/fonc.2023.1233198

 received in 2023-06-01, accepted in 2023-09-04,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundLung cancer is the second most common form of malignant tumor and has the highest mortality rate worldwide. Among its subtypes, lung adenocarcinoma is the most prevalent. Leptomeningeal metastasis (LM) is rare and is characterized by a dismal prognosis, with overall survival periods typically spanning 4 to 6 weeks without treatment. However, in specific cases, survival can be extended to 4 to 6 months with appropriate therapy. The recent approval of third-generation tyrosine kinase inhibitors (TKIs), such as osimertinib, aumolertinib, and furmonertinib, has introduced promising treatment options for individuals with non-small cell lung cancer (NSCLC) who develop LM after developing resistance to first- and second-generation TKIs. These third-generation TKIs exhibit an enhanced ability to penetrate the blood–brain barrier (BBB), opening up new avenues for managing this challenging condition.Case summaryWe report the case of a 48-year-old Chinese man diagnosed with advanced NSCLC harboring an epidermal growth factor receptor (EGFR) mutation. Following a pulmonary lobectomy and postoperative adjuvant therapy with gefitinib, the patient was diagnosed with LM, which was confirmed by his neurologic symptoms, cerebrospinal fluid cytologic analysis, and cranial enhancement magnetic resonance imaging. Subsequently, he received oral treatment in the form of 160 mg of furmonertinib daily. After 5 days of furmonertinib therapy, the patient recovered from lethargy, with an obvious improvement in cognitive function. Follow-up visits revealed a 6-month survival period following the LM diagnosis. Patients with NSCLC and LM typically present with severe symptoms, and the efficacy of systemic treatment, intrathecal chemotherapy, and radiotherapy remains unsatisfactory. We hope that this specific case provide valuable insights into the management of patients with EGFR mutation-associated NSCLC with LM.ConclusionFurmonertinib, a third-generation EGFR TKI with notable BBB penetration, shows promise in LM control and the rapid alleviation of intracranial symptoms. Further investigations into appropriate dosage and toxicity management are imperative.

【 授权许可】

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Copyright © 2023 Chen, Chen, Liu, Shu, Fu, Gou, Lei and Jia