Liu Lan, Wu Jing, Zhao Wei, Huang Mei-Juan
Department of Thoracic Oncology, Cancer Center, West China Hospital, West China Medical School, Sichuan University, Chengdu, Sichuan Province, China.
Medicine (Baltimore). 2017 May;96(21):e6979. doi: 10.1097/MD.0000000000006979.
The c-ros oncogene 1 receptor tyrosine kinase (ROS1)-rearrangements represent a new and rare genetic subtype of non-small-cell lung cancer. In recent years, the use of crizotinib in ROS1-rearranged lung cancer exhibits significant clinical efficacy. Crizotinib is generally well tolerated and the most frequent adverse events include visual disorders, gastrointestinal disturbances, cardiac, and endocrine abnormalities. From a cardiac perspective, crizotinib is associated with 2 main cardiac effects, QT interval prolongation and bradycardia.
We reported a case of a 67-year-old man with ROS1-rearranged advanced lung adenocarcinoma.
Crizotinib was initiated as first-line treatment, combined with whole brain radiation therapy.
Interestingly, after treatment of crizotinib, the patient suffered a transient QTc interval prolongation and his persistent atrial fibrillation was changed into sinus bradycardia. Only 22 days after crizotinib treatment, the patient's tumor achieved a partial response. So far the patient has taken crizotinib for >19 months with no evidence of disease progression.
The present study demonstrates dramatic benefit of crizotinib for patients with ROS1 rearrangement. Besides, we should caution the cardiac effects caused by crizotinb and our case provides evidence that crizotinib may be safe for patients with atrial fibrillation under close monitoring.
c-ros癌基因1受体酪氨酸激酶（ROS1）重排是非小细胞肺癌一种新的罕见基因亚型。近年来，克唑替尼用于ROS1重排的肺癌显示出显著临床疗效。克唑替尼总体耐受性良好，最常见的不良事件包括视觉障碍、胃肠道不适、心脏和内分泌异常。从心脏角度来看，克唑替尼有两种主要心脏效应，即QT间期延长和心动过缓。
我们报告了一例67岁ROS1重排的晚期肺腺癌男性患者。
开始使用克唑替尼作为一线治疗，并联合全脑放射治疗。
有趣的是，克唑替尼治疗后，患者出现短暂的QTc间期延长，其持续性房颤转变为窦性心动过缓。克唑替尼治疗仅22天后，患者肿瘤达到部分缓解。迄今为止，患者服用克唑替尼已超过19个月，无疾病进展迹象。
本研究证明克唑替尼对ROS1重排患者有显著益处。此外，我们应警惕克唑替尼引起的心脏效应，且我们的病例提供了证据表明在密切监测下克唑替尼对房颤患者可能是安全的。
