Multimodality treatment approach in a patient with EGFR-mutated NSCLC and leptomeningeal metastases: A case report and literature review

Rationale: Leptomeningeal metastases in pulmonary adenocarcinoma patients carrying epidermal growth factor receptor mutations present a critical therapeutic dilemma. However, there is no established standard therapy following drug resistance. Novel treatment modalities are urgently needed. Patient concerns: We report a 62-year-old nonsmoking man who presented with multiple bilateral pulmonary nodules and underwent left lower lobectomy in October 2012. Diagnosis: Pathological examination confirmed poorly differentiated adenocarcinoma with neuroendocrine differentiation, classified as clinical stage IV. Interventions: The patient was initially treated with oral osimertinib; however, resistance developed after 6 months. Genetic analysis revealed an epidermal growth factor receptor exon 21 mutation. After a comprehensive treatment plan that included targeted therapy, radiotherapy, chemotherapy, and concurrent therapies. The patient achieved a total survival time of 28 months following the diagnosis of leptomeningeal metastases. Outcomes: The multimodality treatment method described in this case, incorporating whole-brain radiotherapy, intrathecal chemotherapy (dose escalation), and concurrent therapies, prolonged the patient’s survival. Lessons: Integrating a multimodal treatment plan that includes whole-brain radiotherapy and intrathecal administration of pemetrexed disodium could offer a promising treatment option for lung cancer patients with leptomeningeal metastasis.