Pulsed Erlotinib as Sole Treatment of Leptomeningeal Carcinomatosis: Can We Avoid the Use of Intrathecal Therapy?

Leptomeningeal carcinomatosis, a not uncommon complication of non-small cell lung cancer, is associated with poor prognosis, and median survival is reported in case series as weeks to months. The advent of targeted therapy may have positively impacted the prognosis of such patients recently. Standard approaches to treatment of leptomeningeal metastasis include intrathecal chemotherapy with or without cranial or craniospinal radiation and additional systemic therapy. We report a case of leptomeningeal metastasis in epidermal growth factor receptor overexpressing lung adenocarcinoma showing an excellent response with pulsed doses of erlotinib as the only therapy.