BMC Cancer. 2013 Apr 26;13:207. doi: 10.1186/1471-2407-13-207.
Single arm phase 1 and 2 studies on Crizotinib in ALK-positive patients so far have shown rapid and durable responses. Spontaneous pneumothoraces as a result of response to anti-cancer therapy are rare in oncology but have been documented in a number of tumour types including lung cancer. This includes cytotoxic chemotherapy as well as molecular targeted agents such as gefitinib and Bevacizumab. These often require chest drain insertion or surgical intervention with associated morbidity and mortality. They have also been associated with response to treatment. This is the first report we are aware of documenting pneumothorax as response to crizotinib therapy.
A 48-year-old Caucasian male presented with a Stage IV, TTF1 positive, EGFR wild-type adenocarcinoma of the lung. He received first line chemotherapy with three cycles of cisplatin-pemetrexed chemotherapy with a differential response, and then second-line erlotinib for two months before further radiological evidence of disease progression. Further analysis of his diagnostic specimen identified an ALK rearrangement by fluorescence in situ hybridization (FISH). He was commenced on crizotinib therapy 250 mg orally twice daily. At his 4-week assessment he had a chest radiograph that identified a large left-sided pneumothorax with disease response evident on the right. Chest CT confirmed a 50% left-sided pneumothorax on a background of overall disease response. A chest tube was inserted with complete resolution of the pneumothorax that did not recur following its removal.
Our case demonstrates this potential complication of crizotinib therapy and we therefore recommend that pneumothorax be considered in patients on crizotinib presenting with high lung metastatic burden and with worsening dyspnoea.
目前，ALK 阳性患者的克唑替尼单臂 1 期和 2 期研究显示出快速和持久的反应。由于抗癌治疗而导致的自发性气胸在肿瘤学中很少见，但在许多肿瘤类型中都有记录，包括肺癌。这包括细胞毒性化疗以及分子靶向药物，如吉非替尼和贝伐单抗。这些药物通常需要插入胸腔引流管或进行手术干预，伴随一定的发病率和死亡率。它们也与治疗反应有关。这是我们所知的第一份报告，记录了气胸作为克唑替尼治疗反应的案例。
一名 48 岁的白种男性，患有 TTF1 阳性、EGFR 野生型肺腺癌 IV 期。他接受了一线化疗，包括三个周期的顺铂-培美曲塞化疗，但反应不同，然后二线使用厄洛替尼治疗两个月，随后疾病出现进一步的影像学进展。对其诊断标本的进一步分析发现了荧光原位杂交（FISH）的 ALK 重排。他开始接受克唑替尼治疗，每天口服 250 毫克，每天两次。在他的 4 周评估时，他的胸部 X 光片显示左侧大量气胸，右侧可见疾病反应。胸部 CT 证实左侧气胸占 50%，总疾病反应背景下。插入了胸腔引流管，气胸完全缓解，在移除后未再复发。
我们的病例表明了克唑替尼治疗的这种潜在并发症，因此我们建议在有高肺部转移负荷和呼吸困难恶化的接受克唑替尼治疗的患者中考虑气胸。
