Bevacizumab for an erlotinib-resistant metastatic brain tumor contributed to long-term survival in advanced NSCLC: A case report

A 65-year-old female nonsmoker showed an abnormal shadow in the left lung field on X-ray. She underwent a left upper lobectomy and was diagnosed with pulmonary adenocarcinoma at pathological stage IIIA. After 9 months, she received whole-brain radiation therapy because of a brain metastasis in the right parietal lobe. First-line induction therapy with gefitinib was performed for 32 months but the patient failed to respond to the chemotherapy. However, second-line induction therapy with docetaxel led to the shrinkage of lymph nodes. Because of the re-enlargement of lymph nodes, erlotinib, a tyrosine kinase inhibitor (TKI), was started orally and the disease was controlled for 9 years. Due to the recurrence of brain metastasis, induction therapy using bevacizumab (15 mg/kg), a humanized anti-vascular endothelial growth factor (VEGF) monoclonal antibody, was added. After 1 month, contrast-enhanced magnetic resonance imaging revealed that the lesions had shrunk. The patient has now survived for more than 17 years. The addition of monoclonal antibody targeting VEGF would have the advantage of improving outcomes to control brain metastases that may appear in patients with non-small cell lung cancer receiving first-generation TKIs.