Fujiwara Yutaka, Masago Katsuhiro, Matsuzawa Reiko, Yamaguchi Teppei, Watanabe Naohiro, Shimizu Junichi, Sasaki Eiichi, Horio Yoshitsugu
Department of Thoracic Oncology, Aichi Cancer Center, Nagoya, Japan.
Department of Pathology and Molecular Diagnostics, Aichi Cancer Center, Nagoya, Japan.
Case Rep Oncol. 2024 Aug 27;17(1):942-949. doi: 10.1159/000540445. eCollection 2024 Jan-Dec.
Patients with anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (NSCLC) are at increased risk of central nervous system (CNS) metastasis at initial diagnosis and throughout treatment. In a phase 3 trial, lorlatinib, a third-generation ALK tyrosine kinase inhibitor, significantly improved progression-free survival. In further analysis, lorlatinib revealed superior intracranial efficacy and prolonged time to intracranial progression compared with crizotinib.
Herein, we report a case of ALK-positive NSCLC with leptomeningeal metastasis that was successfully treated with lorlatinib after progression to brigatinib and alectinib. This case demonstrates the potential of lorlatinib in managing leptomeningeal metastasis in ALK-positive NSCLC.
The case suggests a paradigm shift in therapeutic approaches for CNS metastasis, including brain and leptomeningeal metastases.
间变性淋巴瘤激酶（ALK）重排的非小细胞肺癌（NSCLC）患者在初始诊断及整个治疗过程中发生中枢神经系统（CNS）转移的风险增加。在一项3期试验中，第三代ALK酪氨酸激酶抑制剂洛拉替尼显著改善了无进展生存期。在进一步分析中，与克唑替尼相比，洛拉替尼显示出卓越的颅内疗效并延长了至颅内进展的时间。
在此，我们报告1例ALK阳性NSCLC伴软脑膜转移的病例，该患者在对布加替尼和阿来替尼耐药后，接受洛拉替尼治疗成功。该病例证明了洛拉替尼在治疗ALK阳性NSCLC软脑膜转移方面的潜力。
该病例提示了CNS转移（包括脑转移和软脑膜转移）治疗方法的范式转变。
