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Parrot A, Canellas A, Barral M, Gibelin A, Cadranel J. [Severe hemoptysis in the onco-hematology patient]. Rev Mal Respir 2024; 41:303-316. [PMID: 38155073 DOI: 10.1016/j.rmr.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/04/2023] [Indexed: 12/30/2023]
Abstract
In France, even though it occurs only exceptionally in cases of hemopathy, severe hemoptysis in cancer is the leading cause of hemoptysis. Without adequate treatment, in-hospital mortality exceeds 60%, even reaching 100% at 6 months. The management of severe hemoptysis should be discussed with the oncologist. Aside from situations of threatening hemoptysis, in which bronchoscopy should be performed immediately, CT angiography is an essential means of localizing the bleeding and determining the causes and the vascular mechanisms involved. In more than 90% of cases, hemoptysis is linked to systemic bronchial or non-bronchial hypervascularization, whereas in fewer than 5%, it is associated with pulmonary arterial origin or, exceptionally, with damage to the alveolar-capillary barrier. The most severely ill patients must be treated in intensive care in centers equipped with interventional radiology, thoracic surgery and, ideally, with interventional bronchoscopy. Interventional radiology is the first-line symptomatic treatment. In over 80% of cases, bronchial arteriography with embolization allows immediate control. Emergency surgery should be avoided, as it is associated with significant mortality. Appropriate and adequate care reduces hospital mortality to 30%, enabling patients to benefit from the most recent, survival-prolonging treatments.
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Affiliation(s)
- A Parrot
- Service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France.
| | - A Canellas
- Service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France
| | - M Barral
- Service de radiologie, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France; UFR médecine, Sorbonne université, 75006 Paris, France
| | - A Gibelin
- Service de médecine intensive et réanimation, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France
| | - J Cadranel
- Service de pneumologie et oncologie thoracique, Assistance publique-Hôpitaux de Paris, hôpital Tenon, Sorbonne université, 75970 Paris, France; UFR médecine, Sorbonne université, 75006 Paris, France
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Gupta K, Uchel T, Karamian G, Loschner A. Pulmonary complications of tyrosine kinase inhibitors and immune checkpoint inhibitors in patients with non-small cell lung cancer. Cancer Treat Res Commun 2021; 28:100439. [PMID: 34333246 DOI: 10.1016/j.ctarc.2021.100439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/13/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
The understanding of cancer biology and the identification of various molecular pathways and targeted oncogenic drivers have led to a paradigm shift in treatment of non-small cell lung cancer. In the last two decades, the therapeutic approach for non-small cell lung cancer (NSCLC) has gradually transitioned from empiric treatment with chemotherapeutic regimens to personalized medicine with precision targets. The major key players in these novel approaches involve targeted therapy, such as tyrosine kinase inhibitors (TKI) and immunotherapy, such as immune checkpoint inhibitors (ICI) blocking intrinsic down regulators of immunity, to achieve anti-cancer effects. These novel agents are generally better tolerated than chemotherapeutics and it is essential to be cognizant of the various drug related adverse effects. Regular follow up of patients with NSCLC by chest computed tomography (CT) surveillance to monitor for disease progression or recurrence is a prerequisite. It is becoming increasingly challenging to identify pulmonary complications related to the use of novel TKI and ICI. Our review focuses on various pulmonary complications of TKI and ICI in patients undergoing treatment for NSCLC, chest CT manifestations, management strategies, and treatment outcomes described in various case reports and case series.
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Affiliation(s)
- Kushagra Gupta
- Department of Pulmonary and Critical Care Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States.
| | - Toribiong Uchel
- Department of Pulmonary and Critical Care Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
| | - Gregory Karamian
- Department of Pulmonary and Critical Care Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
| | - Anthony Loschner
- Department of Pulmonary and Critical Care Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, United States
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Myall NJ, Lei AQ, Wakelee HA. Safety of lorlatinib following alectinib-induced pneumonitis in two patients with ALK-rearranged non-small cell lung cancer: a case series. Transl Lung Cancer Res 2021; 10:487-495. [PMID: 33569330 PMCID: PMC7867755 DOI: 10.21037/tlcr-20-564] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Drug-induced interstitial lung disease (DI-ILD) is a rare adverse event associated with targeted therapies that inhibit the anaplastic lymphoma kinase (ALK) protein. Although newer-generation ALK inhibitors such as alectinib significantly improve survival in metastatic ALK-rearranged non-small cell lung cancer (NSCLC), the risk of DI-ILD is similar to that of earlier-generation therapies. Lorlatinib is a third-generation ALK inhibitor that is active in patients with metastatic NSCLC whose tumors have developed secondary resistance to alectinib. While it is associated with low rates of DI-ILD in initial phase 1/2 clinical trials, the safety of lorlatinib in patients with a history of DI-ILD has not been well-described. In this case series, we therefore report two patients with metastatic ALK-rearranged NSCLC who each tolerated lorlatinib following recovery from alectinib-related DI-ILD. Both cases were notable for the acute onset of dyspnea, hypoxia, and diffuse ground-glass opacities within one month of initiating alectinib. With no alternative etiology of pneumonitis identified, both patients were treated empirically for grade 3 DI-ILD with corticosteroids and discontinuation of alectinib. Following rapid clinical recovery and eventual radiographic resolution of opacities, each patient was started on lorlatinib at the time of cancer progression, with neither person developing symptoms or radiographic findings consistent with recurrent DI-ILD. In the following series, we describe these two cases in greater detail and discuss their significance within the context of the prior literature. While further descriptions are needed, our experience suggests that lorlatinib may be a safe therapeutic option in some patients who have recovered from DI-ILD.
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Affiliation(s)
| | - Amy Q Lei
- Division of Oncology, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, USA
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Hwang HJ, Kim MY, Choi CM, Lee JC. Anaplastic lymphoma kinase inhibitor related pneumonitis in patients with non-small cell lung cancer: Clinical and radiologic characteristics and risk factors. Medicine (Baltimore) 2019; 98:e18131. [PMID: 31770246 PMCID: PMC6890272 DOI: 10.1097/md.0000000000018131] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Anaplastic lymphoma kinase (ALK) inhibitor-related pneumonitis (ALK-IIP) is relatively rare but sometimes fatal, so the timely diagnosis of ALK-IIP is important for enabling prompt management. However, the detailed radiologic characteristics and clinical course of ALK-IIP are still unclear. This study was performed to investigate the clinical and radiologic characteristics and risk factors of ALK-IIP in patients with non-small cell lung cancer (NSCLC).A total of 250 NSCLC patients who had been treated with ALK inhibitors were retrospectively enrolled. Chest computed tomography (CT) was classified into 4 CT patterns using the 2013 guideline for idiopathic interstitial pneumonia: cryptogenic organizing pneumonia (COP), hypersensitivity pneumonitis (HP), acute interstitial pneumonia (AIP), and nonspecific interstitial pneumonia. Clinical characteristics including toxicity grading and treatment course were analyzed in regarding to CT patterns. Clinical characteristics were compared between patients with ALK-IIP and without ALK-IIP.ALK-IIP was identified in 11 patients (4.4%). The most common CT pattern was the COP pattern (n = 7, 63.6%) and followed by HP and AIP patterns (both, n = 2, 18.2%). ALK-IIP showed pneumonitis toxicity grade ranged from 1 to 4, and AIP pattern had the highest toxicity grade, followed by HP and COP patterns (median grade: 3.5, 2.5, 1). All of the patients with the COP pattern were successfully treated, while half of patients with the AIP pattern died during treatment. The smoking history and extrathoracic metastasis were more frequent in patients with ALK-IIP (P < .005). The smoking history was associated with a higher incidence of ALK-IIP (odds ratio: 3.586, 95% confidence interval: 1.058-13.432, P = .049).ALK-IIP showed a spectrum of chest CT patterns, which reflected the toxicity grades. The COP pattern was the most common CT pattern of ALK-IIP, and patients with ALK-IIP of the COP pattern were successfully treated. ALK inhibitors should be used with caution in NSCLC patients with smoking history.
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Affiliation(s)
- Hye Jeon Hwang
- Departments of Radiology and Research Institute of Radiology
| | - Mi Young Kim
- Departments of Radiology and Research Institute of Radiology
| | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, and Division of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Gu, Seoul, South Korea
| | - Jae Cheol Lee
- Department of Pulmonary and Critical Care Medicine, and Division of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-Gu, Seoul, South Korea
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Pistone A, Durieux V, Grigoriu B, Meert AP. Management of Acute Complications of Targeted Therapy in Patients With Cancer: A Review of Cases Managed in ICU. J Intensive Care Med 2018; 34:435-448. [PMID: 30165779 DOI: 10.1177/0885066618787788] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Targeted therapies, molecules in full expansion, are not free of side effects that can lead patients to intensive care. We performed an extensive review of the published evidence and propose a management strategy for acute complications of targeted therapy in critically ill patients with cancer. METHODS The literature search was performed in August 2017 using the Ovid Medline system by a scientific librarian and physicians. We made a review of cases admitted in intensive care unit (ICU) and a review of toxicities of grades greater or equal to 3. RESULTS Our search selected 59 articles. The main cardiovascular side effects requiring ICU are heart failure, which is generally reversible, severe hypertension, thrombotic and ischemic events, and rhythm disturbances. The main pulmonary side effects are interstitial lung disease essentially caused by crizotinib, respiratory infections, pneumothorax, and alveolar hemorrhage. The main gastrointestinal side effects are fulminant hepatitis that may be fatal, colitis that may be complicated by hemorrhage, and perforation. The main neurological side effect is posterior reversible encephalopathy syndrome essentially caused by bevacizumab. The main other side effects are Steven-Johnson syndrome, necrotizing fasciitis, and anaphylactic reactions. CONCLUSIONS The side effects induced by targeted therapies may be fatal but are generally potentially reversible. The main treatment includes stopping current therapy and symptomatic management. Treatment rechallenge should be discussed on a case-by-case basis.
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Affiliation(s)
- Aureliano Pistone
- 1 Unité de soins intensifs et urgences oncologiques, service de médecine interne, Institut Jules Bordet, Université libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Valérie Durieux
- 2 Bibliothèque des Sciences de la Santé, Université libre de Bruxelles (ULB), Bruxelles, Belgium.,3 Laboratoire de Médecine Factuelle, Faculté de Médecine, Université libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Bogdan Grigoriu
- 1 Unité de soins intensifs et urgences oncologiques, service de médecine interne, Institut Jules Bordet, Université libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Anne-Pascale Meert
- 1 Unité de soins intensifs et urgences oncologiques, service de médecine interne, Institut Jules Bordet, Université libre de Bruxelles (ULB), Bruxelles, Belgium
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Parrot A, Gibelin A, Issoufaly T, Voiriot G, Djibré M, Naccache J, Cadranel J, Fartoukh M. Toxicité pulmonaire des médicaments : ce que le réanimateur doit connaître ? MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Kim SH, Minami S, Ogata Y, Yamamoto S, Komuta K. Diffuse Alveolar Hemorrhage Induced by Irinotecan for a Patient with Metastatic Thymic Carcinoma: A Case Report and Literature Review. Intern Med 2017; 56:1697-1700. [PMID: 28674360 PMCID: PMC5519473 DOI: 10.2169/internalmedicine.56.8349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We herein report a 73-year-old Japanese woman with metastatic thymic carcinoma who developed diffuse alveolar hemorrhage (DAH) during irinotecan chemotherapy. She presented with a mild fever and exertional dyspnea after the second cycle of weekly irinotecan monotherapy. Chest images showed diffuse ground-glass opacities. The diagnosis of DAH was based on the findings of the bronchoalveolar lavage fluid, which was bloody and contained hemosiderin-laden macrophages. The discontinuation of irinotecan and introduction of oral prednisolone improved her symptoms and chest abnormal shadows. This is the first case of DAH caused by irinotecan.
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Affiliation(s)
- Sung-Ho Kim
- Department of ER Medical Center, Osaka Police Hospital, Japan
- Department of Respiratory Medicine, Osaka Police Hospital, Japan
| | - Seigo Minami
- Department of Respiratory Medicine, Osaka Police Hospital, Japan
| | - Yoshitaka Ogata
- Department of Respiratory Medicine, Osaka Police Hospital, Japan
| | - Suguru Yamamoto
- Department of ER Medical Center, Osaka Police Hospital, Japan
- Department of Respiratory Medicine, Osaka Police Hospital, Japan
| | - Kiyoshi Komuta
- Department of Respiratory Medicine, Osaka Police Hospital, Japan
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Aggressive Metastatic Inflammatory Myofibroblastic Tumor After Allogeneic Stem Cell Transplant With Fatal Pulmonary Toxicity From Crizotinib. J Pediatr Hematol Oncol 2016; 38:642-645. [PMID: 27271810 DOI: 10.1097/mph.0000000000000594] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Inflammatory myofibroblastic tumors (IMTs) are rare tumors with an intermediate spectrum of biological behavior. IMTs are uncommon secondary malignancies after hematopoietic stem cell transplant. The presence of anaplastic lymphoma kinase rearrangements in 50% of IMTs has led to therapeutic trials with crizotinib, although limited experience remains with crizotinib use in children. We describe the first reported case of a highly aggressive and metastatic IMT (secondary malignancy) in an 8-year-old girl following umbilical cord blood transplant. Although tumor response was demonstrated with anaplastic lymphoma kinase inhibition, she later developed fatal pulmonary toxicity from diffuse alveolar damage, a feature felt most likely to be due to crizotinib.
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Crizotinib Associated with Ground-Glass Opacity Predominant Pattern Interstitial Lung Disease: A Retrospective Observational Cohort Study with a Systematic Literature Review. J Thorac Oncol 2016. [PMID: 26200268 DOI: 10.1097/jto.0000000000000577] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Crizotinib, an oral tyrosine kinase inhibitor that targets anaplastic lymphoma kinase, has proven to offer sustained progression-free survival in anaplastic lymphoma kinase-rearranged non-small-cell lung cancers. Occurrence of severe interstitial lung disease (ILD) was one of the crucial adverse events reported in randomized clinical trials and case reports. METHODS In September 2011, we observed a crizotinib-associated ILD case. Following this index case, we reviewed the clinical and computed tomographic scan features of all patients treated with crizotinib in our department, between October 2010 and July 2013, comparing patients with and without ILD. A systematic literature review was performed. RESULTS During this period, 29 patients were treated with crizotinib, five of whom developed ILD, in addition to the index case. Two types of adverse lung reactions may be observed in patients undergoing crizotinib therapy. The first is a severe, usually fatal, ILD that occurs during the first month of treatment (n = 1). The second is a less severe ILD, occurring later in time (n = 5). It occurs gradually with only few clinical symptoms, but predominant ground-glass opacities on computed tomography, along with an intensive lymphocytic alveolitis in bronchoalveolar lavage fluid. These cases had a longer response with a median progression-free survival duration at 19.9 months (17.9-23.5) compared with 6.2 months (1.2-13.6) for controls (p = 0.04). CONCLUSION Forty-nine cases of crizotinib-associated ILD have been identified by the systematic review of the literature, including our six cases. Two types of adverse lung reactions may be observed with different presentation, prognosis, and treatment. Their potential mechanisms should be clarified. Nine patients with the less severe form of ILD were safely retreated.
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Mussat E, Giraud V, Julie C, Chinet T, Leprieur EG. Fatal Haemoptysis Associated with Dramatic Response to Crizotinib in an ALK-Rearranged Lung Adenocarcinoma. J Clin Diagn Res 2016; 10:XD01-XD03. [PMID: 27134984 DOI: 10.7860/jcdr/2016/17805.7428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/09/2016] [Indexed: 11/24/2022]
Abstract
The presence of an ALK (Anaplastic Lymphoma Kinase) rearrangement is a rare molecular feature in Non-Small Cell Lung Carcinoma (NSCLC), and concerns mainly non- or light smokers, young patients, with adenocarcinoma histological type. These tumours are particularly sensitive to Alk-targeted therapies, as crizotinib. Crizotinib is usually well-tolerated. We report a case of fatal haemoptysis associated with dramatic response to crizotinib in a patient with an ALK-rearranged lung adenocarcinoma. The patient presented a mediastinal invasion with tracheal involvement and compression of the right pulmonary artery. The initial evolution under crizotinib was good with tumour response. At 6 weeks of crizotinib the patient presented a massive haemoptysis with a tracheobronchial fistula and pneumomediastinum. She died of acute respiratory failure. Our case is the first to report a fatal effect of crizotinib associated with tumour necrosis and good tumour response on a massive mediastinal infiltration. Precautions are recommended with the use of crizotinib in proximal lung tumours with vascular invasion.
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Affiliation(s)
- Elodie Mussat
- Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France
| | - Violaine Giraud
- Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France
| | - Catherine Julie
- Faculty, Department of Pathology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France
| | - Thierry Chinet
- Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France. EA 4340 BCOH, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
| | - Etienne Giroux Leprieur
- Faculty, Department of Respiratory Diseases and Thoracic Oncology, Ambroise Pare Hospital - APHP , Boulogne-Billancourt, France. EA 4340 BCOH, UVSQ, Paris-Saclay University, Boulogne-Billancourt, France
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Crizotinib-induced toxicity in an experimental rat model. Wien Klin Wochenschr 2016; 128:435-41. [PMID: 26975454 DOI: 10.1007/s00508-016-0984-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/23/2016] [Indexed: 01/25/2023]
Abstract
AIM The aim of the present study was to evaluate the effect of crizotinib on visceral organs in an experimental rat model. METHODS Eighteen Wistar albino rats were divided into three groups: experimental toxicity was induced with crizotinib (10 mg/kg) administered for 28 days (Group 1), 42 days (Group 2) orally by gavage. Control group received only distilled water. Rats in Group 1 and Group 2 were sacrificed after the collection of blood and tissue samples on the 28th and 42nd days, respectively. RESULTS Subjects in Group 1 and Group 2 had abnormal histology mainly in lung and liver. There were intraalveolar hemorrhage in lungs; mild portal inflammation, perivenular focal and confluent necrosis in liver; inflammatory reaction in renal pelvis and periureteral areas, and focal pancreatitis in pancreas. CONCLUSION This study is the first to evaluate the histopathological features of toxicity of crizotinib in a rat model.
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Overbeck TR, Schmitz K, Engelke C, Sahlmann CO, Hugo S, Kellner L, Trümper L, Schildhaus HU. Partial Response to First-Line Crizotinib in an Elderly Male Patient with ROS1 Translocation-Positive Lung Cancer. Case Rep Oncol 2016; 9:158-63. [PMID: 27065847 PMCID: PMC4821145 DOI: 10.1159/000444745] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
We report on a 90-year-old male patient with a ROS1-translocated adenocarcinoma of the lung who was treated with crizotinib as first-line therapy. After 11 months of treatment, we noticed complete metabolic response as measured by 18F-FDG-PET/CT scan and a partial response according to RECIST criteria. This patient indicates that ROS1 translocations are not restricted to young age, female gender and low stage. Furthermore, this case illustrates exemplarily that crizotinib therapy is effective and manageable even as first-line treatment in elderly patients with comorbidities. Based on our findings, we recommend to include elderly patients with advanced pulmonary adenocarcinomas in molecular screening approaches for ROS1 translocations.
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Affiliation(s)
- Tobias R Overbeck
- Lungentumorzentrum Universität Göttingen and Göttingen Comprehensive Cancer Center (G-CCC), University Hospital Göttingen, Göttingen, Germany; Department of Hematology and Medical Oncology, University Hospital Göttingen, Göttingen, Germany
| | - Katja Schmitz
- Institute of Pathology, University Hospital Göttingen, Göttingen, Germany
| | - Christoph Engelke
- Department of Radiology, University Hospital Göttingen, Göttingen, Germany
| | | | - Sara Hugo
- Institute of Pathology, University Hospital Göttingen, Göttingen, Germany
| | - Laura Kellner
- Institute of Pathology, University Hospital Göttingen, Göttingen, Germany
| | - Lorenz Trümper
- Lungentumorzentrum Universität Göttingen and Göttingen Comprehensive Cancer Center (G-CCC), University Hospital Göttingen, Göttingen, Germany; Department of Hematology and Medical Oncology, University Hospital Göttingen, Göttingen, Germany
| | - Hans-Ulrich Schildhaus
- Lungentumorzentrum Universität Göttingen and Göttingen Comprehensive Cancer Center (G-CCC), University Hospital Göttingen, Göttingen, Germany; Lungentumorzentrum Universität Göttingen and Göttingen Comprehensive Cancer Center (G-CCC), University Hospital Göttingen, Göttingen, Germany
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Teuwen LA, Van den Mooter T, Dirix L. Management of pulmonary toxicity associated with targeted anticancer therapies. Expert Opin Drug Metab Toxicol 2015; 11:1695-707. [PMID: 26293379 DOI: 10.1517/17425255.2015.1080687] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Targeted anticancer therapies act by interfering with defined molecular entities and/or biologic pathways. Because of their more specific mechanism of action, adverse events (AEs) on healthy tissues are intended to be minimal, resulting in a different toxicity profile from that observed with conventional cytotoxic chemotherapy. Pulmonary AEs are rare but potentially life-threatening and it is, therefore, critical to recognize early on and manage appropriately. AREAS COVERED In this review, we aim to offer an overview of both more frequent and rare pulmonary AEs caused by targeted anticancer therapies and discuss possible treatment algorithms. Anti-vascular endothelial growth factor, anti-human epidermal growth factor receptor and anti-CD20 therapy will be reviewed, as well as immune checkpoint inhibitors, anaplastic lymphoma kinase inhibitors and mammalian target of rapamycin inhibitors. EXPERT OPINION Novel agents used in the treatment of cancer have specific side-effects, the result of allergic reactions, on-target and off-target effects. Clinical syndromes associated with pulmonary toxicity vary from bronchospasms, hypersensitivity reactions, pneumonitis, acute respiratory distress, lung bleeding, pleural effusion to pneumothorax. Knowledge of risk factors, a high index of suspicion and a complete diagnostic work-up are essential for limiting the risk of these events becoming life threatening. The development of treatment algorithms is extremely helpful in managing these events. It is probable that these toxicities will be even more frequent with the introduction of combination therapies with the obvious challenge of discerning the responsible agent.
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Affiliation(s)
- Laure-Anne Teuwen
- a 1 Sint-Augustinus, Resident in Internal Medicine , Oosterveldlaan 24, 2610 Wilrijk-Antwerp, Belgium
| | - Tom Van den Mooter
- b 2 Sint-Augustinus, Resident in Medical Oncology , Oosterveldlaan 24, 2610 Wilrijk-Antwerp, Belgium
| | - Luc Dirix
- c 3 Sint-Augustinus, Medical Oncology , Oosterveldlaan 24, 2610 Wilrijk-Antwerp, Belgium +32 34 433 737 ; +32 34 430 09 ;
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Maka VV, Krishnaswamy UM, Anil Kumar N, Chitrapur R, Kilara N. Acute interstitial lung disease in a patient with anaplastic lymphoma kinase-positive non-small-cell lung cancer after crizotinib therapy. Oxf Med Case Reports 2014; 2014:11-2. [PMID: 25988009 PMCID: PMC4369967 DOI: 10.1093/omcr/omu004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 03/06/2014] [Accepted: 03/11/2014] [Indexed: 12/02/2022] Open
Abstract
Crizotinib, an orally active multi-targeted small-molecule anaplastic lymphoma kinase (ALK) inhibitor, is an effective treatment modality for advanced ALK-positive non-small-cell lung cancer (NSCLC). Most drug-related adverse events are mild to moderate; however, some patients may develop acute interstitial lung disease (ILD) which is sometimes fatal. We present a case of crizotinib-associated ILD in a 47-year-old woman treated with crizotinib for metastatic adenocarcinoma of the lung. The patient presented with acute breathlessness and hypoxaemia in the second month of crizotinib therapy; radiological and histopathological work-up was suggestive of acute interstitial pneumonia. The patient improved clinically with corticosteroid therapy and was successfully re-challenged with crizotinib. In conclusion, while treating NSCLC patients with crizotinib, it is important to promptly investigate and treat any new-onset respiratory symptoms, as the latter could represent an adverse effect related to therapy. Prompt discontinuation of the offending drug and initiation of corticosteroid therapy may prevent adverse outcomes.
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Affiliation(s)
- Vinayak V Maka
- Department of Medical Oncology , M. S. Ramaiah Medical College , MSRIT Post, Bangalore 560054 , India
| | | | - N Anil Kumar
- Department of Medical Oncology , M. S. Ramaiah Medical College , MSRIT Post, Bangalore 560054 , India
| | - Rohith Chitrapur
- Department of Medical Oncology , M. S. Ramaiah Medical College , MSRIT Post, Bangalore 560054 , India
| | - Nalini Kilara
- Department of Medical Oncology , M. S. Ramaiah Medical College , MSRIT Post, Bangalore 560054 , India
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