First-line pemetrexed and carboplatin plus anlotinib for epidermal growth factor receptor wild-type and anaplastic lymphoma kinase-negative lung adenocarcinoma with brain metastasis: A case report and review of the literature

Abstract

Rationale: Brain metastasis (BM) is a serious complication in non-small cell lung cancer (NSCLC) patients. Pemetrexed is one of the preferred agents in nonsquamous NSCLC with BM; however, the traditional chemotherapy demonstrated limited efficacy partly due to drug resistance and the blood-brain barrier.

Patient concerns: A 52-year-old male non-smoker was admitted for irritating cough, chest distress, and back pain.

Diagnoses: Epidermal growth factor receptor wild-type, anaplastic lymphoma kinase-negative primary lung adenocarcinoma with an asymptomatic solitary BM (cTxNxM1b, IVA).

Interventions: Pemetrexed (500 mg/m of body surface area) and carboplatin (area under the curve of 5) were firstly administered every 3 weeks for 3 cycles, followed by pemetrexed/carboplatin plus anlotinib (12 mg daily; 2 weeks on and 1 week off) for another 3 cycles. Then maintenance anlotinib monotherapy was continued for a year, without unacceptable adverse events.

Outcomes: The BM was slightly enlarged after 3 cycles of pemetrexed/carboplatin; however, a complete remission was achieved after the combination therapy. His intracranial progression-free survival was more than 2 years.

Lessons: Pemetrexed/carboplatin plus anlotinib could be considered for the treatment of epidermal growth factor receptor wild-type, anaplastic lymphoma kinase-negative lung adenocarcinoma with BM. Further well-designed trials are warranted to verify this occasional finding.

Figure 1

The chest images and cytology of pleural effusion. (A) The chest x-ray radiography showed left-sided pleural effusion and atelectasis of the left lower lobe (November 2015); (B) The computed tomography indicated the atelectasis of the left lower lobe after closed thoracic drainage; (C) The cytology of the drained effusion revealed malignant cells (hematoxylin-eosin staining, ×400).

Figure 2

The brain magnetic resonance imaging. (A) A solitary BM was indicated before the therapy (labeled by the yellow arrow); (B) The intracranial lesion maintained stable after 3 cycles of pemetrexed/carboplatin (labeled by the yellow arrow); (C) A complete remission of the BM was demonstrated 2 yr after the combination treatment using pemetrexed and anlotinib for 3 cycles and maintained anlotinib monotherapy for 1 yr. BM = brain metastasis.