Recovery from paraplegia with administration of erlotinib in a patient with lung adenocarcinoma

Paraplegia caused by spinal cord compression (SCC) due to vertebral metastasis is considered an oncological emergency, and it requires immediate treatment [1–5]. Irradiation of the metastatic lesion and corticosteroid therapy are usually carried out, but the possibility of controlling the lesion is very low [3]. Erlotinib is a molecular targeted drug widely used to treat patients with advanced non-small cell lung cancer (NSCLC), and its clinical utility is highly evaluated [4]. We herein report a paraplegic patient successfully treated with erlotinib in addition to such palliative therapies.
A 77-year-old man was admitted to our hospital with gradual onset of weakness and dysesthesia of the bilateral lower extremities, bladder and bowel disturbance, and back pain of 1-month duration. He was a never smoker. Nine years previously, he had been diagnosed as having adenocarcinoma in the lower lobe of the right lung. As there was no distant metastasis, he received lobectomy and mediastinal lymph node dissection. The pathological staging was T1aN0M0, stage IA (seventh edition of the TNM classification), lepidic-predominant adenocarcinoma. But EGFR mutation was not analyzed at that time. Two months after the surgery, follow-up chest CT scan revealed left pretracheal lymph node recurrence. He received radiotherapy and platinum-containing chemotherapy. At the follow-up 3 years after this additional therapy, he had again developed local recurrence in the left lung. This time, he was treated with gefitinib (250 mg/d). One year after the initiation of gefitinib, he noticed numbness in the area of both knees, which was rapidly progressing to paraplegia. On admission to our hospital, he was unable to walk. Bladder and bowel disturbance was also observed. Additionally, he complained of dysesthesia of the anterior aspects of both legs. Neurologic examination revealed bilateral weakness of the hip adductors, quadriceps femoris, adductor muscles, and posterior tibial muscle (muscle strength grade I/V on the right, II/V on the left). There were no signs of upper neuron damage. Lower extremity reflexes were reduced bilaterally. No pathologic reflexes were noted. Magnetic resonance imaging (MRI) showed vertebral metastases at Th9 and S1, which had destroyed the bodies of these vertebrae, causing SCC (Fig. 1). A metastatic workup to find involvement of the other organs was negative. The lesions were managed with dexamethasone and palliative radiotherapy of up to 36 Gy,...


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