CRA64 WITH GEFITINIB, NOT ALL PLEURAL PROCEDURES ARE NECESSARY

Nor Safiqah Sharil1, Andrea Ban Yu-Lin2, Boon Hau Ng2, Nik Nuratiqah Nik Abeed2, Jae Lim C.K2
1 Internal Medicine Unit, Faculty of Medicine and Health Science, University Sains Islam Malaysia, Negeri Sembilan, Malaysia
2 Faculty of Medicine, University Kebangsaan Malaysia

Introduction

The management of metastatic lung adenocarcinoma with pleural involvement often necessitates pleural interventions to alleviate symptoms and improve quality of life. However, with the advent of targeted therapies such as gefitinib, the necessity of all pleural procedures is being re-evaluated. This case report discusses a 73-year-old female patient with metastatic lung adenocarcinoma complicated by endobronchial invasion causing total left lower lobe collapse and paramalignant pleural effusion. It highlights the role of gefitinib in reducing the need for invasive pleural procedures.

Case Presentation

A 73-year-old Chinese, female and a non-smoker with newly diagnosed advanced metastatic lung adenocarcinoma presented with worsening dyspnoea and a massive left pleural effusion while awaiting mutation study results. Initial management included pleural drainage via chest tube insertion. Despite these interventions, the patient experienced recurrent pleural effusions. Given the lung entrapment and advanced adenocarcinoma, the patient was counselled for an indwelling pleural catheter (IPC). Concurrently, a decision to initiate gefitinib 250 mg daily was made despite pending mutation results. Marked clinical improvement was noted within one week of gefitinib initiation, with radiographic evidence showing a significant reduction in pleural effusion, resolution of lung collapse, and stabilization of respiratory symptoms. Subsequent pleural interventions were deemed unnecessary.

Discussion

The introduction of gefitinib, an EGFR tyrosine kinase inhibitor, has revolutionized the treatment of EGFR-mutant non-small cell lung cancer (NSCLC). Its role extends beyond tumor control to symptom management, particularly in patients with pleural effusion. Patients on gefitinib report improved quality of life and fewer hospital admissions for pleural procedures.

Conclusion

This case underscores the potential of gefitinib to minimize the need for invasive pleural procedures in patients with metastatic lung adenocarcinoma.