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Nishiyama Y, Omori S, Matsumoto H, Komiya K, Hiramatsu K. Lung Injury Induced by Crizotinib and Entrectinib in a Patient with ROS1-rearranged Non-small-cell Lung Cancer. Intern Med 2023; 62:3507-3510. [PMID: 37062732 PMCID: PMC10749824 DOI: 10.2169/internalmedicine.1255-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/02/2023] [Indexed: 04/18/2023] Open
Abstract
We herein report the first case of c-ros oncogene 1 (ROS1)-rearranged advanced non-small-cell lung cancer (NSCLC) in which lung injury was induced by crizotinib and entrectinib. Crizotinib was administered as first-line chemotherapy in a woman in her early 70s with stage IV NSCLC showing ROS1 rearrangement. This resulted in the development of drug-induced organizing pneumonia, which was alleviated by discontinuing drug administration and giving corticosteroids. Following second-line chemotherapy with entrectinib, a similar lung injury was noted. In cases of crizotinib-induced lung injury, physicians must be alert for drug-induced lung injury in subsequent treatment with entrectinib.
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Affiliation(s)
- Yoshiki Nishiyama
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Shota Omori
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Hiroyuki Matsumoto
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Kosaku Komiya
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
| | - Kazufumi Hiramatsu
- Respiratory Medicine and Infectious Diseases, Oita University Faculty of Medicine, Japan
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2
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Fukuda Y, Sagara H. Alectinib-Induced Diffuse Alveolar Hemorrhage. Arch Bronconeumol 2023:S0300-2896(23)00112-6. [PMID: 37080799 DOI: 10.1016/j.arbres.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 04/07/2023]
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周 清, 陆 舜, 李 勇, 贾 福, 李 冠, 洪 震, 卢 铀, 范 云, 周 建, 刘 喆, 李 娟, 吴 一. [Chinese Expert Consensus on Management of Special Adverse Effects
Associated with Lorlatinib]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:555-566. [PMID: 36002192 PMCID: PMC9411957 DOI: 10.3779/j.issn.1009-3419.2022.101.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/28/2022]
Abstract
Anaplastic lymphoma kinase (ALK) fusions represent the second most common oncogenic driver mutation in non-small cell lung cancer (NSCLC). As the new class of 3rd generation of ALK tyrosine kinase inhibitor (TKI), lorlatinib has shown robust potency and brain-penetrant clinical activity against a wide spectrum of multiple resistance mutations within the ALK domain detected during crizotinib and 2nd generation ALK TKI treatment. Lorlatinib is generally well-tolerated with unique adverse drug reaction/adverse event, including hyperlipidemia and central nervous system effects, which are mostly mild to moderate severity and manageable through dosage modifications and/or standard medical intervention. For advanced NSCLC with ALK positivity, patients should be evaluated for baseline characteristics and pre-existing medication, informed of the potential toxicities, and periodically monitored to balance benefits and risks. Moreover, a multidisciplinary group of experts is essential to establish a comprehensive diagnostic and therapeutic strategy.
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Affiliation(s)
- 清 周
- 510080 广州,广东省肺癌研究所,广东省人民医院,广东省医学科学院Guangdong Lung Cancer Institute, Guangdong Provincial People' s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - 舜 陆
- 200030 上海,上海交通大学附属胸科医院肿瘤科Department of Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - 勇 李
- 200040 上海,复旦大学附属华山医院心内科Department of Cardiology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - 福军 贾
- 510120 广州,广东省精神卫生中心精神科Department of Psychiatry, Guangdong Mental Health Center, Guangzhou 510120, China
| | - 冠军 李
- 200030 上海,上海交通大学医学院附属精神卫生中心精神科Department of Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - 震 洪
- 200040 上海,复旦大学附属华山医院神经内科Department of Neurology, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - 铀 卢
- 610041 成都,四川大学华西医院肿瘤科Department of Oncology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - 云 范
- 310022 杭州,浙江省肿瘤医院肿瘤科Department of Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China
| | - 建英 周
- 310003 杭州,浙江大学附属第一医院呼吸科Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China
| | - 喆 刘
- 101149 北京,首都医科大学附属北京市胸科医院肿瘤科Department of Oncology, Beijing Chest Hospital, Capital Medical University, Beijing 101149, China
| | - 娟 李
- 610041 成都,四川省肿瘤医院肿瘤内科Department of Oncology, Sichuan Cancer Hospital, Chengdu 610041, China
| | - 一龙 吴
- 510080 广州,广东省肺癌研究所,广东省人民医院,广东省医学科学院Guangdong Lung Cancer Institute, Guangdong Provincial People' s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
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Skribek M, Rounis K, Tsakonas G, Ekman S. Complications following novel therapies for non-small cell lung cancer. J Intern Med 2022; 291:732-754. [PMID: 35032058 DOI: 10.1111/joim.13445] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The emergence of tyrosine kinase inhibitors and immune checkpoint inhibitors has paved a new era for the management of non-small cell lung cancer, which has for many years lacked major clinical breakthroughs. Historically, 5-year overall survival remained below 5% in individuals with metastatic disease. These novel treatments have led to significant prolongation of survival in the locally advanced and metastatic setting, exceeding 25% in selected populations. However, they present new challenges to clinicians due to their inherently different spectrum of toxicity unique to each specific drug's pharmacodynamic profile. Internists commonly come across these side effects in their daily clinical practice. Their optimal recognition and management are of utmost importance, because it is associated with significant improvements in patient survival outcomes and their quality of life. The aim of this review is to summarize the complications following these novel treatments for non-small cell lung cancer.
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Affiliation(s)
- Marcus Skribek
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Thoracic Oncology Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Konstantinos Rounis
- Thoracic Oncology Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Georgios Tsakonas
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Thoracic Oncology Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Simon Ekman
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Thoracic Oncology Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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Tyczynski JE, Potluri R, Kilpatrick R, Mazumder D, Ghosh A, Liede A. Incidence and Risk Factors of Pneumonitis in Patients with Non-Small Cell Lung Cancer: An Observational Analysis of Real-World Data. Oncol Ther 2021; 9:471-488. [PMID: 33909273 PMCID: PMC8593090 DOI: 10.1007/s40487-021-00150-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/30/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The incidence of pneumonitis, a treatment-related adverse event (AE) in non-small cell lung cancer (NSCLC) patients, has been studied in the United States mostly through clinical trials and retrospective chart reviews. Few analyses of real-world data have been published. This study of a large nationally representative health records database estimated the incidence and predictors of pneumonitis among treated NSCLC patients between 2008 and 2018. METHODS The Optum® electronic health records (EHR) database includes data on over 80 million patients from more than 50 healthcare plans. The cohort of primary NSCLC patients was identified using ICD-9/10 codes. Natural language processing of unstructured data from physicians' notes facilitated extraction of biomarker (epidermal growth factor receptor [EGFR] and programmed death ligand-1 [PD-L1]) status. Cumulative incidence was estimated as the proportion with pneumonitis overall, by clinical characteristics, and line of therapy (LOT) after diagnosis and treatment. Univariate analysis of incidence rates (cases/1000 person-years) enabled the identification of significant predictors of risk. Competing risk regression identified predictors of pneumonitis. RESULTS The cohort included 81,628 patients. Overall, 19.0% developed pneumonitis during any LOT, with a cumulative incidence of 33.7% and 17.0% for patients with a prior history of pneumonitis and those without, respectively. Univariate analyses revealed several factors associated with pneumonitis (p < 0.05). While factors varied between LOTs, common factors included male gender, squamous histology, history of diabetes or pneumonitis, EGFR-negative status, monotherapy immunomodulatory drugs, or history of radiation therapy. Multivariable competing risk regression showed that male gender, history of pneumonitis, EGFR-negative status, use of other targeted therapies, use of immunomodulatory drugs, and history of radiation therapy predicted pneumonitis. CONCLUSION Pneumonitis is significantly associated with NSCLC treatment. Knowledge of its predictors identified in this study may help devise strategies to mitigate its impact, enhancing treatment adherence and improving outcomes.
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Affiliation(s)
| | | | | | | | | | - Alexander Liede
- AbbVie Inc, North Chicago, IL, USA
- AbbVie Limited, Dublin, Ireland
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6
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Yildiz I. Liver and Pancreatic Injury in Response to ALK Inhibitors in a Patient with Primary Signet Ring Cell Carcinoma of the Lung: A Case Report. Case Rep Oncol 2021; 14:107-111. [PMID: 33776691 PMCID: PMC7983653 DOI: 10.1159/000512829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 10/27/2020] [Indexed: 11/21/2022] Open
Abstract
We report a patient with stage IV anaplastic lymphoma kinase (ALK)-rearranged non-small cell lung cancer (primary lung signet ring cell adenocarcinoma) who received serial crizotinib, chemotherapy, and lorlatinib over more than 4 years. The patient discontinued crizotinib after approximately 4 months due to crizotinib-associated hepatotoxicity. Twenty-five days later, when transaminases had normalized, crizotinib was resumed. However, the patient's liver enzymes rapidly increased again, and crizotinib was discontinued. After 6 cycles of platinum-based chemotherapy, lorlatinib was initiated. Hepatotoxicity did not recur with lorlatinib, a next-generation ALK inhibitor, but grade 4 hypertriglyceridemia and acute pancreatitis were induced by lorlatinib after 4 months. To our knowledge, this is the first case report of acute pancreatitis with lorlatinib. Additionally, stereotactic body radiation therapy (SBRT) was performed for residual small primary lesions in the lung without stopping lorlatinib. Given the rarity of radiation pneumonitis, especially with the relatively small fields treated by SBRT, we suspect that lorlatinib enhanced the pulmonary toxicity. Physicians should be aware that ALK inhibitors, such as lorlatinib and crizotinib, have potentially lethal side effects.
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Affiliation(s)
- Ibrahim Yildiz
- Department of Medical Oncology, Acibadem Mehmet Ali Aydinlar University Atakent Hospital, Istanbul, Turkey
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7
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Cherri S, Noventa S, Fanelli M, Calandra G, Prochilo T, Bnà C, Savelli G, Zaniboni A. Drug-Related Pneumonitis in Cancer Treatment during the COVID-19 Era. Cancers (Basel) 2021; 13:1052. [PMID: 33801385 PMCID: PMC7958630 DOI: 10.3390/cancers13051052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/24/2021] [Indexed: 12/17/2022] Open
Abstract
Interstitial lung disease is recognized as a group of diseases with a different etiopathogenesis characterized by chronic lung inflammation with the accumulation of inflammatory cells, lymphocytes and macrophages, and the consequent release of proinflammatory cytokines. Various degrees of pulmonary fibrosis can be associated with this inflammatory condition. Interstitial lung disease related to oncological drugs is a relevant problem in clinical practice. The etiopathogenetic mechanisms underlying this adverse event are not completely known but can be partly explained by the mechanism of action of the drug involved. Therefore, knowledge of the relevance of this potentially fatal adverse event supported by the reported safety data of pivotal studies becomes fundamental in the management of patients. The prompt diagnosis of drug-related pneumonia and the consequent differential diagnosis with other forms of pneumonia allow a rapid suspension of treatment and the establishment of an immunosuppressive treatment if necessary. In the context of the health emergency related to SARS CoV2 infection and COVID-19-related interstitial lung disease, such knowledge holds decisive relevance in the conscious choice of cancer treatments. Our intent was to describe the oncological drugs most correlated with this adverse event by reporting, where possible, the percentages of insurgency in pivotal studies to provide an overview and therefore promote greater awareness of this important toxicity related to oncological treatment.
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Affiliation(s)
- Sara Cherri
- Unit of Medical Oncology, Department of Oncology, Fondazione Poliambulanza, 25124 Brescia, Italy; (S.N.); (T.P.); (A.Z.)
| | - Silvia Noventa
- Unit of Medical Oncology, Department of Oncology, Fondazione Poliambulanza, 25124 Brescia, Italy; (S.N.); (T.P.); (A.Z.)
| | - Martina Fanelli
- Medical Oncology Unit, University Hospital of Modena, 41124 Modena, Italy;
| | - Giulio Calandra
- Unit of Radiology, Department of Diagnostic Imaging, Fondazione Poliambulanza, 25124 Brescia, Italy; (G.C.); (C.B.)
| | - Tiziana Prochilo
- Unit of Medical Oncology, Department of Oncology, Fondazione Poliambulanza, 25124 Brescia, Italy; (S.N.); (T.P.); (A.Z.)
| | - Claudio Bnà
- Unit of Radiology, Department of Diagnostic Imaging, Fondazione Poliambulanza, 25124 Brescia, Italy; (G.C.); (C.B.)
| | - Giordano Savelli
- Nuclear Medicine Department, Fondazione Poliambulanza, 25124 Brescia, Italy;
| | - Alberto Zaniboni
- Unit of Medical Oncology, Department of Oncology, Fondazione Poliambulanza, 25124 Brescia, Italy; (S.N.); (T.P.); (A.Z.)
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8
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Switching to an alternative ALK-inhibitor after alectinib-induced pneumonitis resulted in resolution of this adverse event. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2020. [DOI: 10.1016/j.cpccr.2020.100023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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9
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Weisberg E, Parent A, Yang PL, Sattler M, Liu Q, Liu Q, Wang J, Meng C, Buhrlage SJ, Gray N, Griffin JD. Repurposing of Kinase Inhibitors for Treatment of COVID-19. Pharm Res 2020; 37:167. [PMID: 32778962 PMCID: PMC7417114 DOI: 10.1007/s11095-020-02851-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/03/2020] [Indexed: 12/15/2022]
Abstract
The outbreak of COVID-19, the pandemic disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spurred an intense search for treatments by the scientific community. In the absence of a vaccine, the goal is to target the viral life cycle and alleviate the lung-damaging symptoms of infection, which can be life-threatening. There are numerous protein kinases associated with these processes that can be inhibited by FDA-approved drugs, the repurposing of which presents an alluring option as they have been thoroughly vetted for safety and are more readily available for treatment of patients and testing in clinical trials. Here, we characterize more than 30 approved kinase inhibitors in terms of their antiviral potential, due to their measured potency against key kinases required for viral entry, metabolism, or reproduction. We also highlight inhibitors with potential to reverse pulmonary insufficiency because of their anti-inflammatory activity, cytokine suppression, or antifibrotic activity. Certain agents are projected to be dual-purpose drugs in terms of antiviral activity and alleviation of disease symptoms, however drug combination is also an option for inhibitors with optimal pharmacokinetic properties that allow safe and efficacious co-administration with other drugs, such as antiviral agents, IL-6 blocking agents, or other kinase inhibitors.
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Affiliation(s)
- Ellen Weisberg
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA. .,Department of Medicine, Harvard Medical School, Boston, MA, USA.
| | - Alexander Parent
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Priscilla L Yang
- Department of Cancer Cell Biology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA, USA
| | - Martin Sattler
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Qingsong Liu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui, China
| | - Qingwang Liu
- High Magnetic Field Laboratory, Chinese Academy of Sciences, Hefei, Anhui, China
| | - Jinhua Wang
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, USA
| | - Chengcheng Meng
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sara J Buhrlage
- Department of Cancer Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA
| | - Nathanael Gray
- Department of Biological Chemistry and Molecular Pharmacology, Harvard Medical School, Boston, MA, USA
| | - James D Griffin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
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Choi W, Lim HJ, Park SY, Han JY, Kim HT, Lee JS, Lee Y. Ceritinib-Induced Organizing Pneumonia in Lung Cancer: A Retrospective Analysis. Target Oncol 2020; 15:513-522. [PMID: 32671808 DOI: 10.1007/s11523-020-00733-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Ceritinib is a potent selective ALK inhibitor with a manageable safety profile. In anecdotal reports, ceritinib was associated with organizing pneumonia (OP), which could be confused with disease progression. OBJECTIVE We aimed to delineate the characteristics of OP that occurs during treatment with ceritinib, and evaluate its clinical implications. PATIENTS AND METHODS We retrospectively analyzed 44 lung cancer patients whose tumors harbored ALK or ROS1 fusions and who had received ceritinib. OP diagnosis was based on radiographic and clinical features. Four OP cases were pathologically confirmed. RESULTS Among 44 patients, 22 OP events occurred in 16 (36.4%) patients. The median time to the first event was 17.2 weeks (range 6.7-68.7 weeks). All events were grade 1 or 2. Radiographic features were categorized into four patterns: nodular (54.6%), consolidation (27.3%), parenchymal band (4.5%), and ground-glass opacity (GGO) (13.6%). OP improved in 20 events with drug interruption or corticosteroids. The median duration of OP was 11.3 weeks (range 2-24 weeks). Tumor response rate was 75% in OP-positive and 42.9% in OP-negative groups. The median progression-free survival was 16.7 months [95% confidence interval (CI) 10.1-not applicable (NA)] in OP-positive and 5.4 months (95% CI 3.6-8.4) in OP-negative patients (P = 0.004). The median overall survival was 46.2 months (95% CI 38.1-NA) in OP-positive and 10.5 months (95% CI 6.2-18.9) in OP-negative patients (P < 0.001). CONCLUSION OP occurs frequently during ceritinib treatment and must be distinguished from disease progression. OP could be reversible without fatal complications and its occurrence is associated with better survival outcomes.
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Affiliation(s)
- Wonyoung Choi
- Center for Clinical Trials, National Cancer Center, Goyang, Republic of Korea
| | - Hyun-Ju Lim
- Department of Radiology, National Cancer Center, Goyang, Republic of Korea
| | - Seog-Yun Park
- Department of Pathology, National Cancer Center, Goyang, Republic of Korea
| | - Ji-Youn Han
- Center for Clinical Trials, National Cancer Center, Goyang, Republic of Korea.,Center for Lung Cancer, National Cancer Center, 322 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea
| | - Heung Tae Kim
- Center for Clinical Trials, National Cancer Center, Goyang, Republic of Korea.,Center for Lung Cancer, National Cancer Center, 322 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea
| | - Jin Soo Lee
- Center for Lung Cancer, National Cancer Center, 322 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea
| | - Youngjoo Lee
- Center for Clinical Trials, National Cancer Center, Goyang, Republic of Korea. .,Center for Lung Cancer, National Cancer Center, 322 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea.
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