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Vol.58 No.2 contents | Japanese/English |
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- Case Report -
Concurrent Administration of an Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor and Cytotoxic Anticancer Drug to Treat Epidermal Growth Factor Receptor Gene Mutation-positive and Mutation-negative Lung Cancers
Atsuko Hirabae1, Noriyuki Suzaki1, Takuya Nagata1, Masaomi Marukawa11Department of Internal Medicine, Kagawa Rosai Hospital, Japan
Background. When a molecular-targeted drug shows completely different effects on two lesions, it is difficult to differentiate the metastatic lesion due to tumor heterogeneity from multiple lung cancers, and difficult to treat the lesions as well. Case. A 63-year-old female presented with a right lung tumor after a medical health checkup. She had been diagnosed with stage IV pulmonary adenocarcinoma harboring an epidermal growth factor receptor (EGFR) gene mutation. Gefitinib was started, and the tumor responded well. However, as the nodule in the lower lobe of the left lung, which had been made an initial diagnosis of post-inflammatory change increased. This lesion was diagnosed as EGFR gene mutation-negative lung adenocarcinoma, and gefitinib was discontinued and carboplatin plus paclitaxel combination chemotherapy started instead. The nodule in the left lung shrank; however, the tumor in the right lung grew. As a result, gefitinib was resumed while chemotherapy was continued, and the right lung lesion receded again. After six cycles of carboplatin plus paclitaxel combination therapy, only the left lung lesion showed re-growth, so the therapy was changed to pemetrexed monotherapy, and a temporary effect was confirmed. No exacerbation of adverse events due to gefitinib administration was noted at any time. Conclusion. We were unable to determine which of the two lesions was the metastatic one due to tumor heterogeneity, but an EGFR tyrosine kinase inhibitor administered in combination with cytotoxic anticancer drugs reduced both tumors without exacerbating adverse events.
key words: Epidermal growth factor receptor gene mutation, Epidermal growth factor receptor tyrosine kinase inhibitor, Cytotoxic anticancer drug, Concurrent administration, Heterogeneity
Received: July 24, 2017
Accepted: January 25, 2018
JJLC 58 (2): 127-131, 2018
