Osimertinib Improved Spinal Cord Metastases in Long-Standing Lung Cancer
This lung cancer diagnosis at a glance
- Stage at diagnosis
- Stage IV
- Subtype
- Adenocarcinoma
- Biomarkers
- Initial surgical specimen: no detected EGFR mutation and ALK-negative. Later pleural-fluid tumor: acquired EGFR T790M mutation with no other detected EGFR mutation.
- Sex
- Male
- Spread to
- cervical and mediastinal lymph nodes; bone; brain; lung and pleura; intramedullary spinal cord
- Treatment
- surgery, chemotherapy, radiation, targeted therapy and supportive care
- Outcome
- In Memory
Treatment course, step by step
- Right upper lobectomy was performed.
- Two courses of cisplatin and gemcitabine were given.
- Mediastinal nodal recurrence was treated with 60 Gy radiation.
- Lumbar bone metastases were treated with 30 Gy radiation.
- Nine courses of carboplatin, pemetrexed, and bevacizumab were administered.
- Erlotinib was given for 16 months with stable disease.
- Left femoral metastases were treated with 30 Gy radiation.
- Docetaxel was given as third-line chemotherapy.
- S-1 was given as fourth-line chemotherapy.
- Vinorelbine was given as fifth-line chemotherapy.
- Brain metastases were treated with radiation.
- Afatinib was given as sixth-line therapy.
- Intramedullary spinal cord metastases were treated with 36 Gy radiation.
- Osimertinib was started after acquired EGFR T790M was identified.
- Rehabilitation supported recovery of standing and bladder function.
What happened, in summary
A 52-year-old man had undergone right upper lobectomy for lung adenocarcinoma 12 years earlier, when the tumor was classified pT1N2M0. Two courses of cisplatin and gemcitabine followed. Over the next decade, the cancer repeatedly returned in mediastinal and cervical lymph nodes, bone, brain, lung, pleura, and eventually the spinal cord.
Treatment included 60 Gy radiation to mediastinal nodes, 30 Gy to lumbar bone disease, nine courses of carboplatin, pemetrexed, and bevacizumab, and 16 months of erlotinib with stable disease despite no detected EGFR mutation. Later lines included radiation to the femur, docetaxel, S-1, vinorelbine, brain radiation, and afatinib.
Six months before his final admission, malignant pleural fluid showed an acquired EGFR T790M mutation, although no other EGFR mutation was detected. He then developed rapidly worsening weakness in all four limbs and urinary retention. MRI revealed intramedullary spinal cord metastases from C2 to T2. Emergency radiation to 36 Gy was given, and osimertinib was started after it became available.
The spinal lesions and neurologic symptoms improved. Strength recovered from 2/5 to 4/5, rehabilitation enabled him to stand, and he no longer needed a urinary catheter. Lung cancer remained stable for 14 months on osimertinib. He ultimately died from bacterial pneumonia rather than documented cancer progression.
Where this story comes from
This is a lay summary of an account first published by PMC / PubMed Central. Read the original in full
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Collections this story belongs to
- Stage 4 Lung Cancer 384 stories
- Afatinib for Lung Cancer 37 stories
These are lay summaries of published cancer stories, for information only. No two cancers behave the same way, and nothing here predicts your own diagnosis or replaces advice from your oncology team. Read the full disclaimer