PMC7486631_01
Dynamics of brain metastases on lorlatinib. Axial brain CT showing brain metastases (white arrows) after lorlatinib dose reduction (a). Axial brain MRI (T1 with contrast) performed two months after resuming full dose lorlatinib showing complete resolution of all brain lesions (b).
JO2020-1980891.001.jpg
PMC7486631_01_JO2020-1980891.001.jpg
fig1
Shortly after the last dose reduction, she presented to the ER with new sensory aphasia and headache and brain CT scan revealed new extensive intracranial dissemination (Figure 1(a)). Lorlatinib was promptly resumed at full dose (100 mg/day), with full symptomatic resolution and CR in the following MRI (Figure 1(b)).
PMC7486631_02
Dynamics of brain metastases on osimertinib. Brain MRI (T1 with contrast, axial, and sagittal) showing brain metastases (white arrows) before treatment (a and c) and 1 month after initiating treatment (b and d).
JO2020-1980891.002.jpg
PMC7486631_02_JO2020-1980891.002.jpg
fig2
MRI revealed 2 BM (right frontal and brainstem, Figures (2(a) and 2(c)), while systemic workup revealed no evidence of disease outside the brain. Molecular workup of her original lung tumor showed an EGFR exon 19 deletion. Subsequent MRI scans showed significant response (Figures 2(b) and 2(d)) in both foci.