Maina Renee M, Rader Caroline A, Muenyi Clarisse S, Battini Ramakrishna, Zalamea Nia N, Foretia Denis A
Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA.
College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.
Ann Med Surg (Lond). 2022 Sep 9;82:104601. doi: 10.1016/j.amsu.2022.104601. eCollection 2022 Oct.
Alectinib, a highly potent, highly selective, brain-penetrant anaplastic lymphoma kinase (ALK) inhibitor is now the first line therapy for patients with metastatic ALK-positive non small cell lung cancer (NSCLC).
We report a rare case of pneumoperitoneum following alectinib initiation for metastatic non small cell lung cancer in a 74-year-old African American female. Patient developed abdominal pain approximately 2 weeks after starting alectinib. She was hemodynamically stable, and imaging revealed pneumoperitoneum. Patient was successfully managed non-operatively.
Gastrointestinal perforation presenting as pneumoperitoneum is a very rare complication of alectinib. To our knowledge our patient is only the second case to be reported in the literature since its approval. The complication is likely attributable to the rapid tumor regression in the gastrointestinal tract. Non-operative management should be attempted if possible.
Oncologists should be aware of the risk of gastrointestinal perforation when initiating cytotoxic chemotherapy on patients with metastatic NSCLC. A multidisciplinary approach is critical in appropriately individualizing care in this patient population.
阿来替尼是一种高效、高选择性、可穿透血脑屏障的间变性淋巴瘤激酶（ALK）抑制剂，现已成为转移性ALK阳性非小细胞肺癌（NSCLC）患者的一线治疗药物。
我们报告了一例罕见病例，一名74岁非裔美国女性在开始使用阿来替尼治疗转移性非小细胞肺癌后发生气腹。患者在开始使用阿来替尼约2周后出现腹痛。她血流动力学稳定，影像学检查显示气腹。患者通过非手术治疗成功治愈。
以气腹形式出现的胃肠道穿孔是阿来替尼非常罕见的并发症。据我们所知，自阿来替尼获批以来，我们的患者是文献中报道的第二例。该并发症可能归因于胃肠道肿瘤的快速消退。如果可能，应尝试非手术治疗。
肿瘤学家在对转移性NSCLC患者启动细胞毒性化疗时应意识到胃肠道穿孔的风险。多学科方法对于在该患者群体中适当个体化护理至关重要。
