Liu Zhichao, Bao Youting, Li Butuo, Sun Xindong, Wang Linlin
School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Jinan, 250200, China.
Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Science, No. 440, Ji Yan Road, Jinan, 250017, Shandong, China.
Clin Transl Med. 2018 Jan 9;7(1):1. doi: 10.1186/s40169-017-0178-x.
Advanced ALK-rearranged non-small cell lung cancer (NSCLC) patients will develop acquired resistance after anaplastic lymphoma kinase (ALK) inhibitors therapies. Vascular endothelial growth factor-A (VEGF-A) production and tumor vessel formation were found to be more significantly enriched in ALK-rearrangement NSCLC than that in epidermal growth factor receptor or Kirsten rat sarcoma viral oncogene mutated NSCLC. However, the correlation between ALK rearrangement and the efficacy of bevacizumab (a recombinant humanized IgG1 monoclonal antibody targeting VEGF-A) was still elusive.
We report a case with metastatic NSCLC harboring ALK-rearrangement who was initially resistant to two courses of ALK-Tyrosine Kinase Inhibitor (TKI) therapy, but got a clinical benefit of 7 months of progression free survival after the combined treatment of bevacizumab plus pemetrexed. And the patient tolerated well.
It suggested that bevacizumab combined with pemetrexed might be a preferred option for ALK rearrangement patient who had failed no less than two courses of ALK-TKIs.
晚期间变性淋巴瘤激酶（ALK）重排的非小细胞肺癌（NSCLC）患者在接受ALK抑制剂治疗后会产生获得性耐药。研究发现，与表皮生长因子受体或 Kirsten 大鼠肉瘤病毒癌基因发生突变的NSCLC相比，ALK重排的NSCLC中血管内皮生长因子-A（VEGF-A）的产生和肿瘤血管形成更为显著。然而，ALK重排与贝伐单抗（一种靶向VEGF-A的重组人源化IgG1单克隆抗体）疗效之间的相关性仍不明确。
我们报告了1例伴有ALK重排的转移性NSCLC患者，该患者最初对两疗程的ALK酪氨酸激酶抑制剂（TKI）治疗耐药，但在接受贝伐单抗联合培美曲塞治疗后获得了7个月无进展生存期的临床获益，且患者耐受性良好。
这表明，对于接受不少于两疗程ALK-TKIs治疗失败的ALK重排患者，贝伐单抗联合培美曲塞可能是一个较好的选择。
