Tanigawa Kengo, Mizuno Keiko, Kamenohara Yusuke, Unoki Taiji, Misono Shunsuke, Inoue Hiromasa
Department of Pulmonary Medicine, Graduate School of Medical and Dental Sciences Kagoshima University Kagoshima Japan.
Respirol Case Rep. 2019 Jun 24;7(7):e00454. doi: 10.1002/rcr2.454. eCollection 2019 Oct.
Central nervous system (CNS) metastases from anaplastic lymphoma kinase (ALK)-positive lung cancer often results in failure of ALK-tyrosine kinase inhibitor (TKI) therapy. Patients with uncontrolled CNS metastases receive radiation therapy, which sometimes causes brain radiation necrosis. We added bevacizumab (15 mg/kg, every 3-4 weeks) to the regimen of four ALK-positive lung cancer patients with brain radiation necrosis who were receiving ALK-TKI therapy. A decrease in brain radiation necrosis was seen in all the patients, and an improvement in symptoms was seen in three patients. In one patient who was receiving corticosteroid therapy, we could taper the dose and subsequently discontinue it. While one patient discontinued bevacizumab because of adverse events, the other three continued with the treatment. Therefore, the combination of bevacizumab with ALK-TKI seems to be an effective, manageable, and tolerable treatment for brain radiation necrosis.
间变性淋巴瘤激酶（ALK）阳性肺癌的中枢神经系统（CNS）转移常导致ALK酪氨酸激酶抑制剂（TKI）治疗失败。中枢神经系统转移未得到控制的患者接受放射治疗，这有时会导致脑放射性坏死。我们将贝伐单抗（15mg/kg，每3 - 4周一次）添加到4例接受ALK - TKI治疗且发生脑放射性坏死的ALK阳性肺癌患者的治疗方案中。所有患者的脑放射性坏死均有减轻，3例患者的症状有所改善。在1例接受皮质类固醇治疗的患者中，我们能够逐渐减少剂量并随后停用。虽然1例患者因不良事件停用了贝伐单抗，但其他3例继续接受治疗。因此，贝伐单抗与ALK - TKI联合似乎是治疗脑放射性坏死的一种有效、可管理且可耐受的治疗方法。
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