Beschreibung:
17147 Background: Selected pts with advanced NSCLC might have particular benefit from EGFR tyrosine kinase (TK) inhibitor treatment. We have identified 4 NSCLC pts with BMs who had major responses to G. Methods: Pts characteristics: Pt 1, 62 y/o female, never-smoker (ns), NSCLC, brain and BMs with bone pain; pt 2, 51 y/o male, former smoker (fs), ADC and BMs; pt 3, 51 y/o male, ns, ADC and BMs; pt 4, 50 y/o male, fs, ADC, pleural effusion, BMs and bone pain. Pts 1 and 4 had mixed osteolytic-sclerotic BMs; pts 2 and 3 had osteolytic BMs. Pts were treated with 250 mg/day of G; the dose was increased to 375 mg/day in pt 1 for maximum CNS control. Pts 1 and 4 received G as first-line therapy, pts 2 and 3 as second-line following failure of platinum-containing therapy. Pts 1–3 also received zoledronic acid. Results: Pts 1 and 4 experienced significant decrease in bone pain with G, within hours in pt 1 and by day 3 in pt 4. Pts 1–3 developed rash. Objective regression of primary tumor was observed in all 4 pts. After 3 months of G the bone scan did not change in pt 1 but many lesions became more sclerotic. Bone scans became negative after one year of treatment in pts 2 and 3. Pt 2 had resection of the primary tumor with no recurrence, 26+ months (mos) from diagnosis, 9+ mos from surgery. Pt 1 has had disease control for 7+ mos, pt 3 for 15+ mos. Pt 1 had CNS regression with G. Pt 3 was found to have asymptomatic CNS mets at 6 mos of G, received whole-brain radiation, and remains on G at >1 year. Pt 4 died 6 weeks after starting G from unrelated causes but showed dramatic BMs response by PET. Tumor tissue was available for molecular analyses for pts 2 and 4, who respectively showed EGFR-TK domain G719C mutation in exon 18 and L858R mutation in exon 21. Both mutations have been previously described in NSCLC patients responding to G. Conclusions: G may be effective in the treatment of BMs in some NSCLC patients. [Table: see text]