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ArticleFrontiers in oncology2026

Serial CSF CA19-9 monitoring and CSF genomic profiling in ERBB2-mutant lung adenocarcinoma with leptomeningeal metastasis: a case report.

Qilin Wang, Jing Wen, Beilei Zeng, Chuanyu You, Xinyu Chen, Juncai Ye, Tian Xu, Xueping Yang, Jiahao Chen, Guangzeng Zhou and 2 more

Abstract readCase Reports
In one paragraph

Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

12 authors.

Qilin Wang *Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Jing Wen *Department of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Beilei ZengDepartment of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Chuanyu YouDepartment of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Xinyu ChenDepartment of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Juncai YeDepartment of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Tian XuDepartment of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Xueping YangDepartment of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Jiahao ChenDepartment of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Guangzeng ZhouDepartment of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.
Dongsheng YuanNorth Sichuan Medical College, Nanchong, China.
Yan GuiDepartment of Oncology, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Leptomeningeal metastasis (LM) from ERBB2-mutant lung adenocarcinoma is difficult to treat and monitor because systemic disease and leptomeningeal disease may evolve discordantly. Evidence regarding cerebrospinal fluid (CSF) genomic profiling and serial CSF tumor marker monitoring in ERBB2-mutant non-small cell lung cancer with LM remains limited. We report a 48-year-old woman initially diagnosed with stage IB mucinous lung adenocarcinoma harboring an ERBB2 exon 20 p.G776delinsVC mutation. After surgery and adjuvant chemotherapy, she developed nodal recurrence and later presented with lower back pain and lower-limb numbness. LM was clinically diagnosed based on neurological symptoms, magnetic resonance imaging and CSF cytopathology. She received craniospinal irradiation, systemic therapy and subsequent intrathecal treatment. At month 33, CSF CA19-9 was markedly elevated despite no clear radiographic systemic progression. CSF next-generation sequencing(NGS) detected the same ERBB2 exon 20 p.G776delinsVC mutation as the primary lung tumor, with a higher variant allele fraction in CSF than in lung tissue.The patient subsequently received trastuzumab deruxtecan and sequential intrathecal therapy with pemetrexed, etoposide, cytarabine and pemetrexed rechallenge. Intrathecal treatment was adjusted according to serial CSF CA19-9 levels, neurological status, imaging findings, systemic disease activity and treatment-related toxicities. CSF CA19-9 was not used as a stand-alone criterion for progression or treatment modification.At the latest follow-up, she remained alive more than 36 months after the clinical diagnosis of LM. This case suggests that CSF NGS and serial CSF CA19-9 may provide further insights into disease activity within the integrated assessment of systemic and leptomeningeal disease. Their clinical applicability is still under investigation and necessitates future validation.

Indexed as

CA19-9ERBB2/HER2intrathecal chemotherapyleptomeningeal metastasis (LM)lung adenocarcinoma

Identifiers

PMID42682576
PMCPMC13529540

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