Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc
Journal website http://www.neurores.org

Original Article

Volume 2, Number 1, February 2012, pages 1-9

Temozolomide and/or Erlotinib in the Treatment of Lung Cancer Patients With Progressive Central Nervous System Metastases

Figures

Figure 1.
Figure 1. Images A and B represent coronal T1 post contrast MRIs of the brain from patient 2. Image A is prior to initiation of temozolomide/erlotinib. Image B is 8 weeks later demonstrating a substantial decrease in the size of the lesion, but not meeting PR per RECIST criteria. Images C and D represent sagital T1 post contrast MRIs of the lumbar spine from patient 8. Image C is at the time of diagnosis of CSF involvement of NSCLC. Multiple areas of bulky disease were noted throughout the CSF space. Image D demonstrates SD after four months on erlotinib. The area of decreased signal within the tumor may represent necrosis.
Figure 2.
Figure 2. Axial T1 post contrast MRI of the brain from patient 7 demonstrating a large left parietal region brain metastasis. Image A is at the time of initiation of temozolomide/erlotinib. Image B demonstrates SD six months later.

Table

Table 1. Patients’ Data
 
SCLC: small-cell-lung cancer; NSCLC: non-small-cell lung cancer. *Pathology demonstrated large cell carcinoma with focal glandular and squamous differentiation; **Two patients (patients 7 and 8) had their initial diagnosis of NSCLC made at outside institutions. More detailed histologic information was not available in their records; ***The patient with cytologic evidence of LM also had parenchymal brain metastases. Another patient with concern for LM had increased opening pressure and xanthochromia on lumbar puncture, but negative cytology. A third patient had clinical symptoms and radiographic findings concerning for LM; ****One patient was on temozolomide with concomitant paclitaxel. Another patient was on temozolomide with concomitant irinotecan.
Number of Patients10
Age54 (49 - 77)
Gender
  Male5 (50%)
  Female5 (50%)
Race
  Caucasian7 (70%)
  African-American3 (30%)
Smoker10 (100%)
Histology
  SCLC2 (20%)
  NSCLC8 (80%)
    Squamous cell carcinoma3 (30%)
    Adenocarcinoma4 (40%)
    Large cell*1 (10%)
    Unspecified NSCLC**2 (20%)
Location
  Parenchymal brain metastases10 (100%)
  Leptomeningeal metastases (LM)1 (10%)***
Treatment
  Temozolomide8 (80%)
  Erlotinib8 (80%)
  Additional chemotherapy during temozolomide and/or erlotinib2 (20%)****