Gefitinib successfully administered in a lung cancer patient with leptomeningeal carcinomatosis after erlotinib-induced pneumatosis intestinalis

Abstract

Because she could not swallow a tablet, erlotinib was administered via a feeding tube. Keywords * Pneumatosis intestinalis * Epidermal growth factor receptor tyrosine kinase inhibitor * Leptomeningeal carcinomatosis * Non-small-cell lung cancer Background Pneumatosis intestinalis (PI) is a rare complication of chemotherapy including cytotoxic and molecular-targeted agents [1], and is characterized by multiple gas accumulations within the bowel wall. The gas is thought to come from the intraluminal gastrointestinal system, bacterial production, or a pulmonary source [3]. Besides chemotherapy, PI is associated with various medical conditions, such as collagen-vascular diseases, lupus enteritis, infectious colitis, asthma, acquired immune deficiency syndrome, cystic fibrosis, hematopoietic stem cell transplantation, trauma, and steroid therapy [2–4]. Table 1 Previous case reports of pneumatosis intestinalis following gefitinib and erlotinib treatment Year Author Age Sex EGFR-TKIs CT findings Treatment 2012 Shinagare, et al. 1) N.D. N.D. Erlotinib N.D. N.D. 2012 Iwasaku, et al. 13) 82 F Gefitinib Intramural air within the intestinal wall Conservative therapy 2012 Lee, et al. 14) 66 F Gefitinib Intramural air within the intestinal wall, portal venous air, Infarction of liver Conservative therapy 2014 Hughes, et al. 15) N.D. Three patients N.D. Erlotinib and pertuzumab N.D. N.D. 2015 Ando, et al. 16) 71 M Gefitinib Intramural air within the intestinal wall, ascites Conservative therapy 2016 Maeda, et al. 17) 80 F Gefitinib Intramural air within the intestinal wall, pneumoretroperitoneum, Conservative therapy 2017 Current case 71 F Erlotinib Intramural air within the intestinal wall, pneumoretroperitoneum, pneumomediastinum Conservative therapy EGFR-TKIs Epidermal growth factor receptor tyrosine kinase inhibitors N.D Not described The precise mechanism of PI secondary to EGFR-TKIs is unknown.