Yoshida Tatsuya, Hida Toyoaki, Yatabe Yasushi
Departments of aThoracic OncologybPathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Aichi, Japan.
Anticancer Drugs. 2016 Jul;27(6):573-5. doi: 10.1097/CAD.0000000000000356.
Anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) have shown promising clinical activity in the treatment of non-small-cell lung cancer (NSCLC) that harbors ALK rearrangement. The next-generation ALK-TKI, alectinib, has been reported to have potent efficacy in ALK-positive NSCLC patients including on mutations that confer resistance to crizotinib, which was the first ALK-TKI approved for ALK-positive NSCLC. The efficacy and safety of ALK-TKIs, including crizotinib and alectinib, as the first-line treatment in critically ill patients is unclear. We report one ALK-positive NSCLC patient with poor performance status (PS) and disseminated intravascular coagulation because of respiratory failure and multiple metastases, and experienced the rapid and dramatic response to alectinib without adverse events that can lead to discontinuation and dose reduction of the drug. After a couple of months of treatment with alectinib, radiological review indicated a complete response. The present case is the first reported case of rapid and marked response to alectinib in ALK-positive NSCLC patients who had poor PS and severe organ dysfunction, such as disseminated intravascular coagulation. Further investigation of the safety and efficacy of ALK-TKI for ALK-positive NSCLC patients who are critically ill is warranted.
间变性淋巴瘤激酶（ALK）酪氨酸激酶抑制剂（TKIs）在治疗具有ALK重排的非小细胞肺癌（NSCLC）方面已显示出有前景的临床活性。据报道，新一代ALK-TKI阿来替尼在ALK阳性NSCLC患者中具有强效疗效，包括对赋予对克唑替尼耐药性的突变有效，克唑替尼是首个被批准用于ALK阳性NSCLC的ALK-TKI。包括克唑替尼和阿来替尼在内的ALK-TKIs作为重症患者一线治疗的疗效和安全性尚不清楚。我们报告了1例ALK阳性NSCLC患者，其因呼吸衰竭和多处转移导致体能状态（PS）差和弥散性血管内凝血，并对阿来替尼迅速产生显著反应，且未出现可导致停药和药物减量的不良事件。在接受阿来替尼治疗几个月后，影像学检查显示完全缓解。本病例是首例报道的对阿来替尼迅速且显著反应的ALK阳性NSCLC患者，该患者PS差且存在严重器官功能障碍，如弥散性血管内凝血。有必要进一步研究ALK-TKI对重症ALK阳性NSCLC患者的安全性和疗效。
