A case of lung adenocarcinoma presenting with leptomeningeal carcinomatosis successfully treated with afati-nib after erlotinib-lnduced hepatotoxicity

A 65-year-old man was diagnosed with leptomeningeal carcinomatosis based on the findings of cerebrospinal fluid cytology and magnetic resonance imaging (MRl). Treatment with erlotinib and bevacizumab was initiated, and partial improvement in consciousness and MRl findings were obtained. However, it was difficult to continue the treatment because of elevation in levels of liver enzymes and melena. We switched the treatment to afatinib monotherapy, and his consciousness improved immediately. Progression-free survival and overall survival from the initiation of the treatment with afatinib were 7 and 9.4 months, respectively. This clinical course suggests activity of afatinib for central nervous system lesions of EGFR-mutated lung cancer.