Kamiyoshihara Mitsuhiro, Igai Hitoshi, Matsuura Natsumi, Yazawa Tomohiro, Ohsawa Fumi
Dept. of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital.
Gan To Kagaku Ryoho. 2021 Aug;48(8):1053-1055.
An 89-year-old female who had been clinically diagnosed with primary lung cancer underwent right upper lobectomy and lymph node dissection(ND2a-2). Postoperative pathological staging revealed a stage ⅡA(pT1bN1M0)adenocarcinoma that was negative for an EGFR mutation. Nineteen months after surgery, the patient developed a mediastinal lymph node metastasis, and radiotherapy was prescribed. Thirty-eight months later, she developed new mediastinal/hilar lymph node metastases and was prescribed pemetrexed(500 mg on day 1 of each of 3 weeks)as the first-line therapy. A complete response was evident after 10 courses. However, she developed grade 3 nausea, and pemetrexed was discontinued. During 10 months of follow-up, no new lesion appeared; therefore, follow-up was discontinued. Ninety-three months after surgery, she was referred to our hospital because an abnormal shadow was apparent on chest roentgenography. A thorough examination revealed pleural dissemination, pulmonary metastases, mediastinal/hilar lymph node metastases, an adrenal metastasis, and bone metastases. Although her performance status(PS)was poor(grade 4), as the diagnosis was ALK fusion gene-positive adenocarcinoma, alectinib(600 mg once daily)was commenced as the second-line therapy. Complete response was achieved 14 months later(ie, 108 months after surgery and 89 months after postoperative recurrence). Thus, an octogenarian patient with poor PS and ALK fusion gene-positive adenocarcinoma exhibited a complete response after treatment with alectinib.
一名临床诊断为原发性肺癌的89岁女性接受了右上叶切除术和淋巴结清扫术（ND2a-2）。术后病理分期显示为ⅡA期（pT1bN1M0）腺癌，表皮生长因子受体（EGFR）突变检测为阴性。术后19个月，患者出现纵隔淋巴结转移，接受了放射治疗。38个月后，她出现了新的纵隔/肺门淋巴结转移，开始使用培美曲塞（每3周的第1天500毫克）作为一线治疗。10个疗程后出现完全缓解。然而，她出现了3级恶心，因此停用了培美曲塞。在10个月的随访期间，未出现新病灶，因此停止随访。术后93个月，因胸部X线检查发现异常阴影，她被转诊至我院。全面检查显示有胸膜播散、肺转移、纵隔/肺门淋巴结转移、肾上腺转移和骨转移。尽管她的体能状态（PS）较差（4级），但由于诊断为ALK融合基因阳性腺癌，开始使用阿来替尼（每日一次600毫克）作为二线治疗。14个月后（即术后108个月和术后复发后89个月）实现了完全缓解。因此，一名体能状态差的老年ALK融合基因阳性腺癌患者在接受阿来替尼治疗后出现了完全缓解。
