Lin Xiao, Xie Mengyao, Ma Dandan, Zheng Dandan, Liu Jingjing, Ye Jinyan, Yang Lehe, Lu Yao
The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China.
Affiliated Shaoxing People's Hospital, Zhejiang University, Shaoxing, 312000, Zhejiang, China.
Discov Oncol. 2025 Jul 18;16(1):1363. doi: 10.1007/s12672-025-02904-6.
Anaplastic lymphoma kinase (ALK) inhibitors have been approved for non-small cell lung cancer (NSCLC) patients with ALK-rearrangement. Ceritinib, a clinically approved ALK inhibitor, is associated with some adverse reactions, including organizing pneumonia (OP). However, few cases of ceritinib-induced OP have been reported to date.
A 59-year-old female patient with ALK + lung adenocarcinoma presented with paroxysmal cough lasting 3 months. Antibiotic therapy was not effective, and blood and sputum cultures were negative.
A computed tomography (CT)-guided biopsy of the left upper lung was performed and hematoxylin-eosin staining was consistent with OP. The diagnosis of ceritinib-induced OP was considered based on these results.
Ceritinib was then stopped, and the patient was treated with methylprednisolone (40 mg ivgtt qd) for one week. The dose was lowered to 32 mg po qd with regular follow-up. Later, the patient switched to another ALK inhibitor, ensartinib, for treatment, and the steroid was discontinued after two months.
A Chest CT scan after one week of treatment showed progressive disappearance of lung lesions, and the patient was discharged on oral methylprednisolone (32 mg qd) for two weeks after which the dose was reduced gradually.
OP should be considered when new lesions appear in the lungs of lung cancer patients, and distinguished from infectious pneumonia, metastasis, or cancer progression. In this respect, pathological biopsy plays an important role in diagnosis. In our case, discontinuation of ceritinib and regular steroid administration were effective.
间变性淋巴瘤激酶（ALK）抑制剂已被批准用于治疗ALK重排的非小细胞肺癌（NSCLC）患者。色瑞替尼是一种临床批准的ALK抑制剂，会引发一些不良反应，包括机化性肺炎（OP）。然而，迄今为止，色瑞替尼诱发OP的病例报道较少。
一名59岁的ALK阳性肺腺癌女性患者出现持续3个月的阵发性咳嗽。抗生素治疗无效，血液和痰液培养均为阴性。
对左上肺进行计算机断层扫描（CT）引导下活检，苏木精-伊红染色结果符合OP。基于这些结果，考虑诊断为色瑞替尼诱发的OP。
随后停用色瑞替尼，患者接受甲泼尼龙（40mg静脉滴注，每日1次）治疗1周。剂量减至32mg口服，每日1次，并定期随访。后来，患者改用另一种ALK抑制剂恩沙替尼进行治疗，2个月后停用类固醇药物。
治疗1周后的胸部CT扫描显示肺部病变逐渐消失，患者出院时口服甲泼尼龙（32mg，每日1次）2周，之后逐渐减量。
肺癌患者肺部出现新病变时应考虑OP，并与感染性肺炎、转移或癌症进展相鉴别。在这方面，病理活检在诊断中起重要作用。在我们的病例中，停用色瑞替尼并规律使用类固醇药物是有效的。
