We
report on a 64-year-old man with leptomeningeal
metastasis (LM) from an
epidermal growth factor receptor (EGFR)-mutated
adenocarcinoma of the
lung . He was treated with
paclitaxel ,
cisplatin . After completion of
chemotherapy , he complained of
headache ,
nausea , and
vomiting . EGFR-mutated
tumor cells were identified from the
cerebrospinal fluid (CSF). Second-line
therapy with
gefitinib ,
methotrexate was started. After receiving
gefitinib for 4 weeks, he had no more
headaches or
vomiting . Eleven months after initiation of
gefitinib , he developed
headache and
nausea .
Chest computed
tomography showed
aggravation of
bone metastasis . Third-line
therapy was started with
gemcitabine and
carboplatin . Two weeks later, he experienced
disorientation . After a fourth
relapse within the
central nervous system , the
therapy was switched to
erlotinib and significant improvement of LM was achieved. This case shows that LM can be diagnosed by detecting EGFR
mutation in CSF and EGFR
tyrosine kinase inhibitors are effective for LM from EGFR mutant
non-small cell lung cancer .