Successful treatment of carcinomatous meningitis with erlotinib and whole brain radiotherapy

Carcinomatous meningitis (CM) is a severe complication of lung cancer. Here, we report on two EGFR-mutated patients who attained relatively long survivals by erlotinib treatment after diagnosis of CM. The first case is a 59-year-old woman who was diagnosed as adenocarcinoma harboring an EGFR mutation (L858R); her disease was at stage IV with multiple brain metastases. The time from the initial diagnosis of lung cancer to CM was 364 days. Erlotinib was administered for 5 months, and the survival time from the diagnosis of CM was 278 days. The second case is a 60-year-old man who underwent right lower lobe lobectomy and was diagnosed as adenocarcinoma with an EGFR mutation (E746-750 deletion) and at the pathological stage IIA (pT1N2M0). Later, the disease was recurring as brain metastasis, and progressed to CM 637 days after diagnosis of lung cancer. Erlotinib was administered for 5.5 months, and the survival time from the diagnosis of CM was 281 days. These cases indicate that erlotinib is a reasonable option for the treatment of CM in EGFR-mutated patients.