• Karima Saboundji, Jean-Bernard Auliac, Maurice Pérol, Géraldine François, Henri Janicot, Marie Marcq, Catherine Dubos-Arvis, Aldo Renault, Florian Guisier, Luc Odier, Radj Gervais, and Christos Chouaïd.
• Pneumologie et Oncologie Thoracique, CH François-Quesnay, 2, Boulevard de Sully, 78200, Mantes-la-Jolie, France.
• Target Oncol. 2018 Aug 1; 13 (4): 501-507.

BackgroundThe prognosis of patients with non-small cell lung cancer (NSCLC) who develop leptomeningeal metastasis (LM) is poor.ObjectiveTo assess the clinical efficacy of osimertinib, a third-generation tyrosine-kinase inhibitor (TKI), in patients with epidermal growth-factor receptor (EGFR)-mutated NSCLCs and LM.Patients And MethodsRetrospective study of NSCLC patients with osimertinib-treated EGFR-mutated NSCLC and LM.ResultsTwenty patients (mean age, 61.2 years; 70% women) with adenocarcinoma NSCLC were included in the study. EGFR mutations were reported in exons 18 (n = 2), 19 (n = 7), and 21 (n = 11). Before starting osimertinib, patients had received a mean of 2.3 treatment lines. When LM was diagnosed, all patients had clinical symptoms. Sixteen (80%) patients had a performance status ≥2. At osimertinib initiation, 13 (65%) patients harbored the EGFR-T790M-resistance mutation. Osimertinib was started at 80 (n = 17), 160 (n = 2), or 40 mg/day (n = 1). All 13 (100%) patients with the T790M mutation and 4 (57%) of those without it obtained clinical responses. Among the 11 radiologically assessable patients, 9 (82%) responded, with 5 responses reported within 15 days after treatment initiation. Median overall survival and progression-free survival were 18.0 and 17.2 months, respectively, from the start of osimertinib.ConclusionsIn this non-selected population, osimertinib had remarkable efficacy in NSCLC patients with LM irrespective of the presence of the EGFR-T790M-resistance mutation. Osimertinib efficacy was rapid in several patients, even some with poor performance status.

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