University Clinic of Radiotherapy and Oncology, Faculty of Medicine, Skopje, Macedonia Skopje, R.N. Macedonia.
Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2020 Sep 1;41(2):29-36. doi: 10.2478/prilozi-2020-0030.
Anaplastic lymphoma kinase (ALK) rearrangement is identified in approximately 3-7% of all metastatic non-small cell lung cancer (NSCLC) patients, and ALK tyrosine kinase inhibitors (TKIs) have revolutionized the management of this subset of lung cancer cases.
This study aims to show alectinib (TKI) effectiveness and safety with focus on alectinib intracranial efficacy for ALK+ NSCLC patients.
Patient 1 was a 46-year-old woman diagnosed with non-small cell lung cancer with an echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion gene (ALK+). She presented with intracranial and liver metastases and poor performance status of ECOG 3. Alectinib was initiated as a second line therapy, after whole brain irradiation and discontinuation of first line chemotherapy after two cycles, due to the central nervous system progression and liver metastases. Good response was consequently achieved, characterized with improved overall performance and without significant adverse events. Patient 2 was a 53-year old man with left sided lung adenocarcinoma surgically treated in 2017. Post-operative pTNM stage was IIB with a positive resection margin- R1. He received adjuvant chemotherapy and radiotherapy. In 2019, after two and half years of being disease free, he presented with severe cerebral symptoms leading to poor performance status. CT scan of the brain showed multiple brain metastases. He was treated with first line alectinib after completion of whole brain radiotherapy. In 5 months period he got significantly better and able for work again.
We recommend alectinib as a first and second line treatment approach for ALK+ NSCLC patients, in particular the ones with brain metastases at the time of diagnosis and poor PS.
大约 3-7%的转移性非小细胞肺癌（NSCLC）患者中存在间变性淋巴瘤激酶（ALK）重排，ALK 酪氨酸激酶抑制剂（TKI）的出现彻底改变了这部分肺癌病例的治疗方式。
本研究旨在展示艾乐替尼（TKI）的有效性和安全性，重点关注艾乐替尼对 ALK+ NSCLC 患者的颅内疗效。
患者 1 为 46 岁女性，诊断为非小细胞肺癌，存在棘皮动物微管相关蛋白样 4-间变性淋巴瘤激酶融合基因（ALK+）。她有颅内和肝转移，ECOG 表现状态为 3 分。在全脑放疗和一线化疗因中枢神经系统进展和肝转移而中断后，她开始接受二线治疗，即艾乐替尼治疗。随后取得了良好的反应，表现为整体表现改善，且无明显不良反应。患者 2 为 53 岁男性，于 2017 年接受左侧肺腺癌手术治疗。术后 pTNM 分期为 IIB，切缘阳性-R1。他接受了辅助化疗和放疗。2019 年，在无病生存两年半后，他出现严重的脑部症状，导致表现状态不佳。脑部 CT 扫描显示多发脑转移。在全脑放疗完成后，他接受了一线艾乐替尼治疗。在 5 个月的时间里，他的病情明显好转，能够重新工作。
我们建议将艾乐替尼作为 ALK+ NSCLC 患者的一线和二线治疗方法，特别是那些在诊断时已有脑转移和较差表现状态的患者。
