A case of long-term survival of gefitinib-induction therapy for advanced N2-multistation lung cancer without epidermal growth factor receptor gene mutation

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A 62-year-old female with a productive sputum was pointed out of a mass of 2.5 cm in diameter in left S4 with lymphadenopathy of station 10, 4, and 3 on computed tomographic scan, which were heterogeneously enhanced by radiocontrast agent. She was diagnosed with pulmonary adenocarcinoma and clinical stage IIIA (T1N2M0, N2-multistation). First-line induction therapy of cisplatin plus paclitaxel had been performed but failed to respond to the chemotherapy. Second-line induction therapy of gefitinib for 6 months had showed the shrinkage of the tumor and resulted in a down-stage (T1N0M0, IA). Positron emission topography revealed no abnormal accumulations of the primary tumor and the mediastinal lymph nodes. As salvage surgery, left upper lobectomy was performed and the pathology revealed negative findings of metastasis in lymph nodal station 4, 5, 6, 7, and 11 but in a positive in station 10. The viable cells in the tumor had been residual (Ef.2) and diagnosed with stage IIA (pT1N1M0). Detection test of epidermal growth factor receptor gene mutation showed a negative result. The patient obtained 5-year's long-term survival without metastasis and recurrence. The combination therapy of gefitinib-induction therapy followed by surgery for advanced lung cancer with N2-multistation would have an advantage of good outcome for such patient in the limited gefitinib-responded population as tailor-made therapies.