2023 World Conference on Lung Cancer (Posters)-EP12.01. Long Survival in LM NSCLC Treated with Aumolertinib and Metronomic Intrathecal Pemetrexed under Dynamic Detection of CSF ctDNA

EP12.01. Long Survival in LM NSCLC Treated with Aumolertinib and Metronomic Intrathecal Pemetrexed under Dynamic Detection of CSF ctDNA - PDF(Slides)

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Leptomeningeal metastases (LM) are characterized by low clinical diagnosis rates, poor treatment efficacy, and short survival. However, the use of cerebrospinal fluid (CSF) can better reflect gene mutations and monitor drug resistance mechanisms. In this case study, a patient with EGFR L858R mutation in their intracranial lesion was identified through CSF ctDNA testing. The patient was treated with aumolertinib, a third-generation EGFR-TKI with high blood-brain barrier penetration, and metronomic intrathecal pemetrexed, which led to remission of the intracranial lesions. The patient experienced long-term disease control and is currently under close follow-up.<br /><br />The case presentation details the treatment history of the patient, including previous chemotherapy treatments and relapses. The increase in cerebrospinal fluid pressure and abundance of CSF ctDNA EGFR mutation prompted the addition of intrathecal pemetrexed as supplementary treatment. The efficacy of the treatment resulted in stable disease (SD) during follow-ups.<br /><br />Overall, the case demonstrates that CSF ctDNA detection can be beneficial in guiding treatment decisions for patients with LM. By identifying gene mutations and monitoring treatment response, physicians can switch to more targeted therapies and improve the effectiveness of the treatment, potentially achieving long-term survival. Although lumbar puncture for CSF ctDNA detection may be slightly invasive, its use is necessary to understand the situation of intracranial lesions and optimize treatment strategies.<br /><br />In conclusion, this case highlights the importance of CSF ctDNA monitoring in the management of LM. The combination of aumolertinib and metronomic intrathecal pemetrexed shows promise in achieving long-term disease control and improving survival time in patients with LM and EGFR mutation.

Asset Subtitle

Zhao Dai

Meta Tag

Speaker Zhao Dai

Topic Metastatic NSCLC: Targeted Therapy - EGFR/HER2

Keywords

Leptomeningeal metastases

cerebrospinal fluid

gene mutations

drug resistance mechanisms

CSF ctDNA testing

aumolertinib

EGFR L858R mutation

metronomic intrathecal pemetrexed

long-term disease control

LM and EGFR mutation