• Chu Zhang, Feng-Wei Kong, Wen-Bin Wu, Miao Zhang, Guang-Mao Yu, Xiang Wang, and Yuan-Yuan Liu.
• Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing.
• Medicine (Baltimore). 2020 Sep 4; 99 (36): e22128.

RationaleBrain metastasis (BM) is a serious complication in non-small cell lung cancer (NSCLC) patients. Pemetrexed is one of the preferred agents in nonsquamous NSCLC with BM; however, the traditional chemotherapy demonstrated limited efficacy partly due to drug resistance and the blood-brain barrier.Patient ConcernsA 52-year-old male non-smoker was admitted for irritating cough, chest distress, and back pain.DiagnosesEpidermal growth factor receptor wild-type, anaplastic lymphoma kinase-negative primary lung adenocarcinoma with an asymptomatic solitary BM (cTxNxM1b, IVA).InterventionsPemetrexed (500 mg/m of body surface area) and carboplatin (area under the curve of 5) were firstly administered every 3 weeks for 3 cycles, followed by pemetrexed/carboplatin plus anlotinib (12 mg daily; 2 weeks on and 1 week off) for another 3 cycles. Then maintenance anlotinib monotherapy was continued for a year, without unacceptable adverse events.OutcomesThe BM was slightly enlarged after 3 cycles of pemetrexed/carboplatin; however, a complete remission was achieved after the combination therapy. His intracranial progression-free survival was more than 2 years.LessonsPemetrexed/carboplatin plus anlotinib could be considered for the treatment of epidermal growth factor receptor wild-type, anaplastic lymphoma kinase-negative lung adenocarcinoma with BM. Further well-designed trials are warranted to verify this occasional finding.

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