Year-end Sale % OFF 
Abstract
Tumour lysis syndrome (TLS) represents a group of fatal metabolic derangements resulting from the rapid breakdown of tumour cells. TLS typically occurs soon after the administration of chemotherapy in haematologic malignancies but is rarely observed in solid tumours. Here, we report a case of brigatinib-induced TLS after treatment with sequential anaplastic lymphoma kinase (ALK) inhibitors in a patient with advanced ALK-rearranged lung adenocarcinoma. The patient was treated sequentially with crizotinib, alectinib, and ensartinib. High-throughput molecular profiling after disease progression indicated that brigatinib may overcome ALK resistance mutations, so the patient was administered brigatinib as the fourth-line treatment. After 22 days of therapy, he developed oliguria, fever, and progressive dyspnoea. Clinical manifestations and laboratory findings met the diagnostic criteria for TLS. The significant decrease in the abundance of ALK mutations in plasma indicated a therapeutic response at the molecular level. Consequently, the diagnosis of brigatinib-induced TLS was established. To the best of our knowledge, this is the first case of TLS induced by sequential targeted therapy in non-small cell lung cancer. With the extensive application of sequential therapy with more potent next-generation targeted therapeutic drugs, special attention should be given to this rare but severe complication.
Highlights
Tumour lysis syndrome (TLS) is a life-threatening oncology emergency
A few cases of TLS have been reported in non-small cell lung cancer (NSCLC), most of which are induced by chemotherapy (Myint et al, 2015)
We describe a patient with metastatic anaplastic lymphoma kinase (ALK)-rearranged NSCLC who received multiple prior ALK inhibitors during his treatment course and subsequently died from brigatinibinduced TLS
Summary
Tumour lysis syndrome (TLS) is a life-threatening oncology emergency. It is induced by a massive release of intracellular contents into the circulation when tumour cells breakdown spontaneously or after the initiation of chemotherapy (Howard et al, 2011). In April 2020, the patient experienced progressive left pleural effusion and started receiving brigatinib (90 mg once daily and 180 mg once daily at 1 week) as the fourth-line treatment. The patient immediately received intubation and mechanical ventilation for progressive respiratory failure He was subsequently treated with vigorous volume expansion, torasemide, sodium polystyrene sulfonate, calcium gluconate, and ceftazidime. Despite these aggressive medical interventions, his clinical and biochemical parameters did not improve, and continuous renal replacement therapy was required. The patient and his family refused emergent haemodialysis or further interventions due to the dismal prognosis. He was transitioned to comfort care and passed away within 24 h
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
