Activity of gefitinib in central nervous system metastases in patients with non-small-cell lung cancer: two case reports and a review of the literature.

Gefitinib is the first inhibitor of the epidermal growth factor receptor that has shown activity in non-small-cell lung cancer (NSCLC), but its potential value in the treatment of central nervous system (CNS) metastases has been rarely assessed. We report 2 cases of patients with CNS metastases responding to gefitinib and a review of all the cases previously published in the literature. Computerized and manual searches were performed to identify reports of patients with NSCLC with CNS metastases treated with gefitinib. Ten reports including 16 cases were identified. Of 18 patients, which included our 2 cases, 14 (78%) were female and 4 (22%) were male. Histologic type was reported in 15 cases, and 12 of them (80%) were adenocarcinomas. Five patients exhibited a complete response (28%) and the rest were partial responses. In addition, we identified 5 series of NSCLC patients with CNS metastases treated with gefitinib, and response rates ranged from 0 to 33%. In conclusion, gefitinib can induce long-lasting responses in NSCLC patients with CNS metastases. Responses have been most frequently observed in female patients with adenocarcinoma. Gefitinib may be an effective and well-tolerated option for selected NSCLC patients with CNS metastases.