Tuberc Respir Dis.  2011 Oct;71(4):286-290.

Successful Rechallenge with Gefitinib for an Initial Erlotinib-Responder with Advanced Lung Adenocarcinoma

• Hong SC
• Sim YS
• Lee JH
• Ryu YJ
• Chang JH

Abstract

Although failure of epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKI) is generally believed to be associated with cross-resistance to other EGFR TKI, the benefit of administering erlotinib as a second EGFR TKI after resistance of gefitinib as the first TKI has been well known. However, good response to gefitinib after an initial response to erlotinib has been rare. We report that a 45-year-old woman (never smoked), with lung adenocarcinoma and EGFR mutation, showed an initial response to erlotinib, and then responded to gefitinib again.

Keyword

erlotinib; gefitinib; Adenocarcinoma of lung

MeSH Terms

Adenocarcinoma
Female
Humans
Lung
Lung Neoplasms
Middle Aged
Protein-Tyrosine Kinases
Quinazolines
Receptor, Epidermal Growth Factor
Erlotinib Hydrochloride
Adenocarcinoma
Lung Neoplasms
Protein-Tyrosine Kinases
Quinazolines
Receptor, Epidermal Growth Factor

Figure

• 

  Figure 1 (A) A chest radiograph showed multiple nodules in both lungs. (B) Computed tomography of chest showed a primary mass (an arrow) in right lower lobe with multiple nodules in both lungs (Jun-2007). (C) The EGFR sequencing disclosed a deletion in exon 19 (del.nt 2235-2249). EGFR: epidermal growth factor receptor.

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  Figure 2 Computed tomography of chest shows (A) a mass in right lower lobe (an arrow) and multiple nodules (May-2008). (B) After erlotinib treatment, the mass was markedly reduced and cavity formation was seen (an arrow, Sep-2008) and (C) multiple tiny nodule in both lungs were noted (Sep- 2008). (D) A metastatic nodule had newly appeared in left lower lobe (an arrow head, May-2009).

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  Figure 3 (A) Chest radiograph and (C) computed tomography (CT) of chest in Apr 2010 showed that a mass [an arrow (A) and an arrowhead (C)] in right lower lobes. (B) Chest radiograph and (D) CT of chest in Jul 2010 showed that the mass [an arrow (B) and an arrowhead (D)] was decreased after gefitinib treatment.

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  Figure 4 Time course of anti-cancer treatment, carcinoembryonic antigen level (diamonds), and radiologic finding since initial diagnosis of lung adenocarcinoma. *Vinorelbine+cisplatin; F: figure.

Reference

1. Lynch TJ, Bell DW, Sordella R, Gurubhagavatula S, Okimoto RA, Brannigan BW, et al. Activating mutations in the epidermal growth factor receptor under-lying responsiveness of non-small-cell lung cancer to gefitinib. N Engl J Med. 2004. 350:2129–2139.

2. Cho BC, Im CK, Park MS, Kim SK, Chang J, Park JP, et al. Phase II study of erlotinib in advanced non-small-cell lung cancer after failure of gefitinib. J Clin Oncol. 2007. 25:2528–2533.

3. Wong AS, Soong R, Seah SB, Lim SW, Chuah KL, Nga ME, et al. Evidence for disease control with erlotinib after gefitinib failure in typical gefitinib-sensitive Asian patients with non-small cell lung cancer. J Thorac Oncol. 2008. 3:400–404.

4. Chang JW, Chou CL, Huang SF, Wang HM, Hsieh JJ, Hsu T, et al. Erlotinib response of EGFR-mutant gefitinib-resistant non-small-cell lung cancer. Lung Cancer. 2007. 58:414–417.

5. Gridelli C, Maione P, Galetta D, Colantuoni G, Del Gaizo F, Ferrara C, et al. Three cases of long-lasting tumor control with erlotinib after progression with gefitinib in advanced non-small cell lung cancer. J Thorac Oncol. 2007. 2:758–761.

6. Kim HK, Ahn MI, Yoo J, Kim CH, Yang HJ, Shim BY. Sequential responses of adenocarcinoma of the lung to erlotinib after gefitinib in never smoker Korean woman. Cancer Res Treat. 2007. 39:37–39.

7. Wong AS, Seto KY, Chin TM, Soo RA. Lung cancer response to gefitinib, then erlotinib, then gefitinib again. J Thorac Oncol. 2008. 3:1077–1078.

8. Wu SG, Shih JY, Yu CJ, Yang PC. Lung adenocarcinoma with good response to erlotinib after gefitinib treatment failure and acquired T790M mutation. J Thorac Oncol. 2008. 3:451–452.

9. Kobayashi S, Boggon TJ, Dayaram T, Jänne PA, Kocher O, Meyerson M, et al. EGFR mutation and resistance of non-small-cell lung cancer to gefitinib. N Engl J Med. 2005. 352:786–792.

10. Viswanathan A, Pillot G, Govindan R. Lack of response to erlotinib after progression on gefitinib in patients with advanced non-small cell lung cancer. Lung Cancer. 2005. 50:417–418.

11. Fukui T, Otani S, Hataishi R, Jiang SX, Nishii Y, Igawa S, et al. Successful rechallenge with erlotinib in a patient with EGFR-mutant lung adenocarcinoma who developed gefitinib-related interstitial lung disease. Cancer Chemother Pharmacol. 2010. 65:803–806.

12. Yokouchi H, Yamazaki K, Kinoshita I, Konishi J, Asahina H, Sukoh N, et al. Clinical benefit of read-ministration of gefitinib for initial gefitinib-responders with non-small cell lung cancer. BMC Cancer. 2007. 7:51.