Successful therapy with bevacizumab combined with corticosteroids for crizotinib-induced interstitial lung disease

Xiaohong Xie,Xinqing Lin,Chengzhi Zhou,Yinyin Qin,Ming Ouyang,Shiyue Li,Bingpeng Guo

doi:10.1007/s10456-019-09673-1

Abstract

We present the case of an old woman with ALK-rearranged stage IV lung adenocarcinoma who received crizotinib. She presented with severe dyspnea on the 34th day, and diffuse ground-glass opacifications in her chest. A diagnosis of crizotinib-induced ILD was confirmed. Corticosteroids were administered. However, the disease was still progressing rapidly. Therefore, as a monoclonal antibody against vascular endothelial growth factor, bevacizumab was administered in low doses (200 mg on days one and three). Her symptoms began to improve. Our clinical experience indicates that bevacizumab combined with corticosteroids might be a promising treatment in crizotinib-induced ILD patients.

Highlights

The patient was a 59-year-old woman with stage IVb lung adenocarcinoma T4N3M1c. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (CT) revealed metastatic lesions involving the left lower lobe and left hilar, mediastinum, bilateral supraclavicular region, multiple retroperitoneal lymph nodes, and left pleura; multiple metastases in the liver and bone metastases of the entire body, and bone
Showed diffusing bilateral increased ground-glass opacity and reticulation. b Chest X-ray showing diffused bilateral ground-glass opacity. c Chest X-ray showing diffused bilateral ground-glass opacity after treatment with methylprednisolone and bevacizumab. d Chest CT scans showing that the diffuse lesions of both lungs were improved and the pleural effusion decreased significantly
Chest CT scans showed that the diffuse lesions of both lungs were significantly absorbed, and the pleural effusion was significantly reduced seven days after anlotinib treatment (Fig. 1d)

Summary

Introduction

The patient was a 59-year-old woman with stage IVb lung adenocarcinoma T4N3M1c. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (CT) revealed metastatic lesions involving the left lower lobe and left hilar, mediastinum, bilateral supraclavicular region, multiple retroperitoneal lymph nodes, and left pleura; multiple metastases in the liver and bone metastases of the entire body, and bone. Keywords Crizotinib · Anaplastic lymphoma kinase · Interstitial lung disease · Bevacizumab Crizotinib was administered twice daily at a dose of 250 mg. Twenty-one days after the initiation of crizotinib treatment, she showed no adverse effects, and there was a decrease in the neurogene-specific enolase value, anti-non-small-cell-lung cancer (NSCLC) in the serum.

Results

Conclusion