Treatment of Metastatic Brain Lesion Using Osimertinib: A Case Report

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Abstract

INTRODUCTION: The article presents clinico-radiological examination data of a female patient with a metastatic brain lesion identified four years after a right upper lobectomy for lung adenocarcinoma. The results of dynamic magnetic resonance imaging (several examinations with intervals from three months to one year) from the onset of the first neurological signs, progression of the disease, to the regression of the pathological focus were analyzed. The molecular genetic study revealed deletion in exon 19 of the EGFR gene and mutation of the Т790M gene. Consequently, osimertinib, a third-generation tyrosine kinase inhibitor with a higher ability to penetrate the hematoencephalic barrier than the first and second generations, was initiated.

CONCLUSION: The presented clinical case demonstrated the positive therapeutic effect of osimertinib on a patient with a metastatic brain lesion identified four years after the right upper lobectomy for lung adenocarcinoma, which was confirmed by a reduction of the volume of the metastatic focus and an absence of contrast accumulation via magnetic resonance imaging.

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About the authors

Svetlana S. Kazakova

Yas Hospital

Author for correspondence.
Email: kz-swetlana@yandex.ru
ORCID iD: 0000-0002-8760-2527
SPIN-code: 2234-3604

Cand. Sci. (Med.), Associate Professor

Oman, Al Buraimi

Ekaterina V. Dushina

Ryazan State Medical University

Email: d.dushin@bk.ru
ORCID iD: 0000-0002-9157-7643

Ассистент кафедры фтизиатрии с курсом лучевой диагностики

Russian Federation, Ryazan

References

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  2. NCCN Clinical practice guidelines in oncology (NCCN guidelines®). Non-Small Cell Lung Cancer. Version 5.2019. Available at: http://tomocenter.com.ua/wp-content/uploads/Non-small-cell-lung-cancer.pdf.
  3. Planchard D, Popat S, Kerr K, et al. Metastatic non-small cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2018;29(4):iv192–237. doi: 10.1093/annonc/mdy275
  4. John T, Akamatsu H, Delmonte A, et al. EGFR mutation analysis for prospective patient selection in AURA3 phase III trial of osimertinib versus platinum–pemetrexed in patients with EGFR T790M–positive advanced non-small-cell lung cancer. Lung Cancer. 2018;126:133–8. doi: 10.1016/j.lungcan.2018.10.027
  5. Mok TS, Wu Y–L, Ahn M–J, et al. Osimertinib or platinum– pemetrexed in EGFR T790M–positive lung cancer. The New England Journal of Medicine. 2017;376(7):629–40. doi: 10.1056/NEJMoa1612674

Supplementary files

Supplementary Files
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2. Fig. 1. Axial magnetic resonance imaging scans with contrast enhancement show foci with an accumulation of contrast agent in the left hemisphere of the cerebellum (a) and near the anterior horn of the right lateral ventricle (b).

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3. Fig. 2. Axial magnetic resonance imaging scans of the brain. A lesion with increased signal intensity and marked perifocal edema is visualized near the anterior horn of the right lateral ventricle on T2-WI (a), with ring accumulation of the contrast agent on T1-WI (b).

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4. Fig. 3. T2-WI shows a solid mass lesion (4.3 cm × 4.0 cm × 3.1 cm in size) with scalloped contours, surrounded by marked perifocal edema, localized predominantly in the white matter of the right frontal lobe near the anterior horn of the lateral ventricle (a). Post-contrast T1-WI shows ring contrast enhancement in the mass lesion (b).

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5. Fig. 4. T2-WI (a), FLAIR (b), and post-contrast T1-WI (c,d) scans demonstrate a focal lesion of irregular shape in the right frontal lobe (at the level of the middle frontal gyrus), 4.1 cm × 2.9 cm × 3.0 cm in size, with areas of subacute hemorrhage, with a non-uniform peripheral accumulation of contrast agent.

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6. Fig. 5. T1-WI (a), T2-WI (b), and post-contrast T1-WI (c) show a focal lesion with uneven contours and heterogeneous MR signal (due to peripheral hemorrhagic areas) 2.1 cm × 1.8 cm × 2.0 cm in size near the anterior horn of the right lateral ventricle, with mild perifocal edema, without reliable accumulation of the contrast agent.

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Copyright (c) 2022 Kazakova S., Dushina E.


Media Registry Entry of the Federal Service for Supervision of Communications, Information Technology and Mass Communications (Roskomnadzor) PI No. FS77-76803 dated September 24, 2019.



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