Shimada Masahiro, Tamura Atsuhisa, Yokosuka Kyoko, Kusaka Kei, Matsui Hirotoshi, Nagai Hideaki, Ohta Ken
Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo 204-8585, Japan.
Respir Investig. 2018 Jul;56(4):365-368. doi: 10.1016/j.resinv.2018.04.004. Epub 2018 Jul 2.
In current guidelines, the role of immune checkpoint inhibitors is not yet determined in the treatment strategy for NSCLC harboring ALK translocations.
A 51-year-old woman with lung adenocarcinoma harboring ALK translocation was treated with alectinib until PD. After the second (CDDP/PEM) and third (crizotinib) line treatment, a second biopsy was performed, revealing PD-L1 tumor proportion score of 70-80% and G1202R mutation of ALK. Pembrolizumab was selected for the fourth line, leading to PR for more than 6 months.
While alectinib might induce resistance to ALK-TKI, it could increase PD-L1 positive cells to become sensitive to PD-1/PD-L1 inhibitors.
在当前指南中，免疫检查点抑制剂在伴有ALK易位的非小细胞肺癌治疗策略中的作用尚未确定。
一名51岁患有伴有ALK易位的肺腺癌女性患者接受阿来替尼治疗直至疾病进展。在二线（顺铂/培美曲塞）和三线（克唑替尼）治疗后，进行了二次活检，结果显示PD-L1肿瘤比例评分70-80%以及ALK的G1202R突变。四线治疗选择了帕博利珠单抗，获得了超过6个月的部分缓解。
虽然阿来替尼可能会诱导对ALK-TKI的耐药性，但它可能会增加PD-L1阳性细胞，使其对PD-1/PD-L1抑制剂敏感。
