Gefitinib successfully administered in a lung cancer patient with leptomeningeal carcinomatosis after erlotinib-induced pneumatosis intestinalis

BMC Cancer. 2018 Aug 16;18(1):825. doi: 10.1186/s12885-018-4743-5.

Abstract

Background: Pneumatosis intestinalis (PI) is a rare complication of chemotherapy, characterized by multiple gas accumulations within the bowel wall.

Case presentation: A 71-year-old woman with epidermal growth factor receptor (EGFR) mutation-positive lung adenocarcinoma was admitted to our hospital because of reduced consciousness. She was diagnosed as having leptomeningeal carcinomatosis (LM) using lumbar puncture. Because she could not swallow a tablet, erlotinib was administered via a feeding tube. Her state of consciousness gradually improved, but she experienced diarrhea several times a day. After 3 weeks of erlotinib therapy, PI occurred. Erlotinib was discontinued and PI was resolved after treatment with conservative therapies. Erlotinib was re-administrated and PI occurred again. After improvement of erlotinib-induced PI, gefitinib was administered by a feeding tube and the patient did not experience PI or diarrhea. The patient survived 8 months from the diagnosis of LM.

Conclusion: PI is one of the side effects of erlotinib, and consecutive therapies are useful for the treatment of PI. In this patient, gefitinib was successfully administered after erlotinib-induced PI.

Keywords: Epidermal growth factor receptor tyrosine kinase inhibitor; Leptomeningeal carcinomatosis; Non-small-cell lung cancer; Pneumatosis intestinalis.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • ErbB Receptors / antagonists & inhibitors
  • Erlotinib Hydrochloride / administration & dosage
  • Erlotinib Hydrochloride / adverse effects
  • Female
  • Gefitinib
  • Humans
  • Lung Neoplasms / complications
  • Lung Neoplasms / drug therapy*
  • Lung Neoplasms / pathology
  • Meningeal Carcinomatosis / complications
  • Meningeal Carcinomatosis / drug therapy*
  • Meningeal Carcinomatosis / pathology
  • Pneumatosis Cystoides Intestinalis / chemically induced
  • Pneumatosis Cystoides Intestinalis / drug therapy*
  • Pneumatosis Cystoides Intestinalis / pathology
  • Protein Kinase Inhibitors / administration & dosage
  • Protein Kinase Inhibitors / adverse effects
  • Quinazolines / administration & dosage*

Substances

  • Protein Kinase Inhibitors
  • Quinazolines
  • Erlotinib Hydrochloride
  • EGFR protein, human
  • ErbB Receptors
  • Gefitinib