Alectinib induced CNS radiation necrosis in an ALK+NSCLC patient with a remote (7 years) history of brain radiation
| Autor: | Michael Weitz, Vanessa Wong, John R. Jalas, Daniel F. Kelly, Samuel J. Klempner, Sai-Hong Ignatius Ou, Oliver Quines, Michele C. Azada |
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| Rok vydání: | 2016 |
| Předmět: |
0301 basic medicine
Pulmonary and Respiratory Medicine Oncology Alectinib Male Cancer Research medicine.medical_specialty Pathology Lung Neoplasms medicine.drug_class Pyridines Central nervous system Carbazoles Adenocarcinoma of Lung Adenocarcinoma 03 medical and health sciences Brain radiation Necrosis 0302 clinical medicine Crizotinib Piperidines Internal medicine medicine Anaplastic lymphoma kinase Humans Anaplastic Lymphoma Kinase Radiation Injuries Pseudoprogression Protein Kinase Inhibitors business.industry Brain Neoplasms Brain Receptor Protein-Tyrosine Kinases Middle Aged Discontinuation ALK inhibitor Radiation necrosis 030104 developmental biology medicine.anatomical_structure Treatment Outcome 030220 oncology & carcinogenesis Disease Progression Pyrazoles business |
| Zdroj: | Lung cancer (Amsterdam, Netherlands). 96 |
| ISSN: | 1872-8332 |
| Popis: | Alectinib is a second generation ALK inhibitor that has significant clinical activity in central nervous system (CNS) metastases in anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC). Pseudoprogression (PsP) due to radiation necrosis during alecitnib treatment of central nervous system (CNS) metastases from ALK-rearranged NSCLC as been reported. Hence, distinguishing radiation-related PsP from alectinib-induced radiographic changes is important to avoid erroneous early trial discontinuation and abandonment of an effective treatment. However, it remains difficult to assess casuality of radiation necrosis is related to recent direct radiation or induced by alectinib treatment or both. It is also unknown how long from previous radiation can alectinib still induce radiation necrosis. Here we reported a crizotinib-refractory ALK-positive NSCLC patient who develop radiation necrosis in one of his metastatic CNS lesions after approximately 12 months of alectinib treatment who otherwise had on-going CNS response on alectinib. His most recent radiation to his CNS metastases was 7 years prior to the start of alectinib. This case illustrates that in the setting of pror CNS radiation, given the significant clinical activity of alectinib in CNS metastases in ALK-positive NSCLC patients the risk of CNS radiation necrosis remains long after previous radiation to the CNS metastases has been completed and can occur after durable response of treatment. |
| Databáze: | OpenAIRE |
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