Ryu Woo Kyung, Cha Hyungkeun, Park Mi Hwa, Kim Jung Soo, Choi Jeong-Seok, Kim Lucia, Lee Kyung-Hee, Nam Hae-Seong
Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea.
Front Oncol. 2022 Oct 18;12:900966. doi: 10.3389/fonc.2022.900966. eCollection 2022.
Crizotinib is an oral selective small-molecular tyrosine kinase inhibitor (TKI) that suppress the activity of anaplastic lymphoma kinase (ALK) and ROS1 kinases, as well as mesenchymal-epithelial transition. The cumulative clinical trials in patients with advanced ALK- or ROS1-rearrangement NSCLC indicate that crizotinib has significant antitumor activity and a tolerable safety profile, with mild or moderate adverse events of visual disorders, diarrhea, nausea, and vomiting. As with other TKIs, however, the occurrence of crizotinib-related interstitial lung disease (crizotinib-ILD) remains a major clinical dilemma that can lead to the permanent discontinuation of TKI during cancer treatment. When there is no suitable alternative therapy for patients who develop crizotinib-ILD, some clinicians have reported successful crizotinib retreatment in cases of ALK-rearrangement NSCLC. Unfortunately, there are no specific guidelines for the treatment or retreatment of TKI-related ILD. We herein report the first successful crizotinib retreatment after crizotinib-ILD in a patient with ROS1-rearranged NSCLC, and suggest a retreatment strategy after crizotinib-ILD based on a literature review.
克唑替尼是一种口服选择性小分子酪氨酸激酶抑制剂（TKI），可抑制间变性淋巴瘤激酶（ALK）和ROS1激酶的活性，以及间质-上皮转化。针对晚期ALK或ROS1重排的非小细胞肺癌（NSCLC）患者的累积临床试验表明，克唑替尼具有显著的抗肿瘤活性和可耐受的安全性，视觉障碍、腹泻、恶心和呕吐等不良事件为轻度或中度。然而，与其他TKI一样，克唑替尼相关的间质性肺病（克唑替尼-ILD）的发生仍然是一个主要的临床难题，可能导致在癌症治疗期间永久停用TKI。当克唑替尼-ILD患者没有合适的替代治疗方法时，一些临床医生报告了在ALK重排的NSCLC病例中成功进行克唑替尼再治疗的情况。不幸的是，对于TKI相关ILD的治疗或再治疗没有具体的指南。我们在此报告了第一例ROS1重排的NSCLC患者在发生克唑替尼-ILD后成功进行克唑替尼再治疗的病例，并基于文献综述提出了克唑替尼-ILD后的再治疗策略。
