Division of Thoracic Oncology, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
Division of Diagnostic Radiology, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
Invest New Drugs. 2019 Feb;37(1):184-187. doi: 10.1007/s10637-018-0633-6. Epub 2018 Jul 3.
The recent approval of anaplastic lymphoma kinase (ALK) inhibitors for the treatment of ALK-rearranged non-small cell lung cancer (NSCLC) has dramatically transformed cancer therapy. However, leptomeningeal metastases (LM) are frequent and often devastating complications of ALK-rearranged NSCLC, and treatment against LM remains challenging. Herein we report a case of a 19-year-old male diagnosed with ALK-rearranged NSCLC with LM. He experienced heavy treatment before introduction of alectinib therapy, which continued for approximately 5.5 years with marked efficacy. However, he experienced recurrence of a bulbar metastasis after discontinuation of alectinib. Reintroduction of standard-dose alectinib therapy resolved the lesion again. Our findings suggest that ALK-tyrosine kinase inhibitor therapy should be continued in patients showing a long-term complete response, unless intolerable toxicities are present, and that rechallenge treatment with alectinib may represent a therapeutic option for central nervous system metastases.
最近，间变性淋巴瘤激酶 (ALK) 抑制剂获批用于治疗 ALK 重排的非小细胞肺癌 (NSCLC)，这极大地改变了癌症治疗格局。然而，ALK 重排 NSCLC 常发生且具毁灭性的脑膜转移 (LM) 仍是治疗难点。在此，我们报告了一例 ALK 重排 NSCLC 合并 LM 的 19 岁男性病例。他在接受艾乐替尼治疗前经历了大量治疗，治疗持续了约 5.5 年，疗效显著。然而，他在停止艾乐替尼治疗后出现了延髓转移的复发。重新给予标准剂量的艾乐替尼治疗再次解决了该病灶。我们的发现表明，ALK 酪氨酸激酶抑制剂治疗应在患者表现出长期完全缓解的情况下继续进行，除非存在无法耐受的毒性，并且艾乐替尼的再次治疗可能是中枢神经系统转移的一种治疗选择。
