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Why is it important?
Afatinib, an irreversible EGFR-TKI, is believed to be able to overcome EGFR mutations resistant to first generation EGFR-TKIs. However, inadequate CSF concentration on standard dose afatinib is reasonably suspected in our patient. A call for clinical trials testing high dose afatinb in leptomeningeal carcinomatosis from non-small cell lung cancer is raised based on our experience. High dose, pulatile erlotinib migh still be tried in such conditions.
Perspectives
Afatinib is generally considered to be stronger in anti-NSCLC carrying EGFR gene mutations than erlotinib and gefitinib. However, inadequate concentration in CSF might be a problem in treating leptomeningeal carcinomatosis. Shifting to high dose erlotinib deserves a trial when afatinib failed to do its job. I hope that a clinical trial of high dose afatinib will be launched soon.
Dr. Frank S. Fan
Read the Original
This page is a summary of: Rapid Response to High-Dose, Pulsatile Erlotinib in Afatinib-Refractory Leptomeningeal Carcinomatosis from Adenocarcinoma of the Lung: A Case Report, Case Reports in Oncology, September 2016, Karger Publishers,
DOI: 10.1159/000449405.
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