Dramatic response to alectinib in a patient of ALK-rearranged lung cancer with poor performance status.

Hisashi Tanaka,Ken Okumura,Masamichi Itoga,Shingo Takanashi,Kunihiko Nakamura,Kageaki Taima,Takeshi Morimoto,Yoshihito Tanaka

doi:10.1186/s13104-016-1983-9

Abstract

BackgroundLung cancers with anaplastic lymphoma kinase rearrangements are highly sensitive to anaplastic lymphoma kinase tyrosine kinase inhibition, underscoring the notion that such cancers are addicted to anaplastic lymphoma kinase activity. Several anaplastic lymphoma kinase inhibitors have been identified and are being evaluated in clinical trials. However patients with poor performance status (3 or 4) were not involved in these clinical trials, it has been unclear to use anaplastic lymphoma kinase–tyrosine kinase inhibitors for these patients. Here, we report an anaplastic lymphoma kinase-positive non small cell lung cancer patient with performance status 4, who was successfully treated with alectinib.Case presentationWe report on a 52-year-old patient diagnosed as non small cell lung cancer harboring echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase fusion gene. His performance status was 4 because of severe respiratory failure. We treated this patient with alectinib as the first line therapy. Dramatic response was obtained and his performance status improved from 4 to 1 without severe adverse events.ConclusionAlectinib is a therapeutic option for the anaplastic lymphoma kinase positive patients with poor performance status.

Highlights

Lung cancers with anaplastic lymphoma kinase rearrangements are highly sensitive to anaplastic lymphoma kinase tyrosine kinase inhibition, underscoring the notion that such cancers are addicted to anaplastic lymphoma kinase activity
The alanine aminotransferase (ALT) level was 19 U/L before treatment, the maximum ALT level was 59 U/L during treatment. This adverse event was manageable. His performance status (PS) improved from 4 to 1, the Karnofsy Performance Scale (KPS) improved from 10 to 90 %, and he discharged in 4 weeks his PS improved from 4 to 1 and he discharged in 4 weeks
The echinoderm microtubule-associated protein-like 4 (EML4)-anaplastic lymphoma kinase (ALK), a fusion gene first described in 2007, possesses oncogenic activity that can be blocked by ALK inhibitor [2], and Rikova et al [3] described two ALK fusion partners

Summary

Background

Non small cell lung cancer (NSCLC) is the leading cause of cancer-related deaths worldwide. Platinumbased chemotherapy is not recommended for patients with poor performance status (PS) of 3 or 4. A chest computed tomography (CT) showed a tumor in the right lower lung with atelectasis and multiple lung metastases in bilateral lung fields (Fig. 1a). Bone scintigraphy showed a hot spot on his lumber vertebrate, and clinical stage was IV (cT4N3M1b). As for his breathing state, SpO2 was around 90 % under the conditions of an oxygen flow rate 10 L/min with reservoir. In 3 weeks, chest CT showed dramatic shrinkage of the primary tumor in the right lower lobe and bilateral multiple lung metastases (Fig. 1b). The ALT level was 19 U/L before treatment, the maximum ALT level was 59 U/L during treatment His PS improved from 4 to 1, the Karnofsy Performance Scale (KPS) improved from 10 to 90 %, and he discharged in 4 weeks his PS improved from 4 to 1 and he discharged in 4 weeks

Discussion

Conclusions