1
|
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.
Collapse
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
| |
Collapse
|
2
|
Tachi H, Nishino K, Nakaizumi T, Kuramoto K, Shimizu K, Yamamoto Y, Kobayashi K, Ichimura H, Sakata A, Nawa T. A case of ROS1-rearranged lung adenocarcinoma exhibiting pleural effusion caused by crizotinib. Thorac Cancer 2020; 11:2063-2066. [PMID: 32433811 PMCID: PMC7327693 DOI: 10.1111/1759-7714.13496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/30/2020] [Accepted: 05/02/2020] [Indexed: 11/30/2022] Open
Abstract
Reports of crizotinib-induced pleural effusion in non-small cell lung cancer (NSCLC) are limited. A 35-year-old Japanese woman was diagnosed with ROS1-rearranged lung adenocarcinoma (primary left lower lobe, cT4N3M1c). Crizotinib was administered as first-line therapy, and the primary and mediastinal hilar lymph node metastases rapidly shrank. On the fourth day of treatment, chest X-ray demonstrated contralateral pleural effusion. On the 41st day of treatment, crizotinib was discontinued because of grade 3 neutropenia. Examination including surgical thoracoscopy did not reveal causative findings, and the continued cessation of drug administration enabled the right pleural effusion to decrease gradually and disappear, suggesting that this event was a side effect of crizotinib. The disease did not progress even though the drug was withdrawn for more than one year. In conclusion, crizotinib was considered to cause pleural effusion as an adverse event in a case of ROS1-rearranged lung adenocarcinoma with a complete response.
Collapse
Affiliation(s)
- Hiroaki Tachi
- Department of Respiratory MedicineHitachi General Hospital, Hitachi Ltd.Hitachi CityJapan
| | - Kengo Nishino
- Department of Respiratory MedicineHitachi General Hospital, Hitachi Ltd.Hitachi CityJapan
| | - Taisuke Nakaizumi
- Department of Respiratory MedicineHitachi General Hospital, Hitachi Ltd.Hitachi CityJapan
| | - Kenya Kuramoto
- Department of Respiratory MedicineHitachi General Hospital, Hitachi Ltd.Hitachi CityJapan
| | - Kei Shimizu
- Department of Respiratory MedicineHitachi General Hospital, Hitachi Ltd.Hitachi CityJapan
| | - Yusuke Yamamoto
- Department of Respiratory MedicineHitachi General Hospital, Hitachi Ltd.Hitachi CityJapan
| | - Keisuke Kobayashi
- Department of Thoracic SurgeryHitachi General Hospital, Hitachi Ltd.Hitachi CityJapan
| | - Hideo Ichimura
- Department of Thoracic SurgeryHitachi General Hospital, Hitachi Ltd.Hitachi CityJapan
| | - Akiko Sakata
- Department of PathologyHitachi General Hospital, Hitachi Ltd.Hitachi CityJapan
| | - Takeshi Nawa
- Department of Respiratory MedicineHitachi General Hospital, Hitachi Ltd.Hitachi CityJapan
| |
Collapse
|
3
|
Koshikawa K, Terada J, Abe M, Iwasawa S, Sakayori M, Yoshioka K, Hirasawa Y, Kasai H, Kawasaki Y, Tsushima K, Tatsumi K. Clinical characteristics and risk factors of drug-induced lung injury by ALK tyrosine kinase inhibitors: A single center retrospective analysis. Thorac Cancer 2020; 11:1495-1502. [PMID: 32237210 PMCID: PMC7262910 DOI: 10.1111/1759-7714.13416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/15/2020] [Accepted: 03/16/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND If anaplastic lymphoma kinase (ALK) gene rearrangement in lung cancer is identified, ALK-tyrosine kinase inhibitors (ALK-TKIs) can be an effective treatment. However, the details of drug-induced lung injury (DILI) caused by ALK-TKI, which can be a serious side effect of ALK-TKIs, remains unclear. This study aimed to investigate the clinical features and the onset risk factors of DILI by ALK-TKIs in clinical practice. METHODS The clinical features of 56 consecutive patients who received crizotinib, alectinib, and/or ceritinib at our hospital from 2012 to 2018 were retrospectively examined. Among these, patients diagnosed with DILI due to ALK-TKIs were evaluated in terms of clinical features and parameters. Each clinical parameter before the administration of ALK-TKIs was compared between the DILI onset group and the non-onset group. RESULTS A total of seven cases were diagnosed with DILI due to ALK-TKIs; no DILI-related deaths were observed. Chest computed tomography (CT) scan findings identified six patients with the organizing pneumonia (OP) pattern and one with the hypersensitivity pneumonia pattern. The onset of DILI was significantly different in patients age ≥ 64 years and with a creatinine clearance <80 mL/minute. CONCLUSIONS Extra caution for DILI due to ALK-TKIs may be needed when recommending ALK-TKIs for patients over 64 years of age, or with decreased renal function. CT images of the majority of patients with DILI by ALK-TKIs show an OP pattern. KEY POINTS Significant findings of the study: Extra caution is needed when recommending ALK-TKIs for patients over 64 years of age or those with decreased renal function. Computed tomography images of the majority of patients with DILI by ALK-TKIs show an OP pattern. WHAT THIS STUDY ADDS The same or a different ALK-TKI may be considered as a treatment option after the onset of DILI, based on careful judgment.
Collapse
Affiliation(s)
- Ken Koshikawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Jiro Terada
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Mitsuhiro Abe
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shunichiro Iwasawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masashi Sakayori
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Keiichiro Yoshioka
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yasutaka Hirasawa
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hajime Kasai
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Kenji Tsushima
- Department of Pulmonary Medicine, International University of Health and Welfare, School of Medicine, Narita city, Chiba, Japan
| | - Koichiro Tatsumi
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| |
Collapse
|
4
|
Li X, Xu H, Gao F, Kang X, Zhang J, Zhao J, Lin Y, Liu X. [Efficacy and Safety of Crizotinib in Advanced or Recurrent
ALK-positive Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2019; 22:488-493. [PMID: 31451138 PMCID: PMC6717874 DOI: 10.3779/j.issn.1009-3419.2019.08.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Anaplastic lymphoma kinase (ALK) positive in non-small cell lung cancer (NSCLC) was about 5%-7% and ALK tyrosine kinase inhibitor (TKI) was the standard treatment in NSCLC. The aim of this study is to evaluate the efficacy and safety of crizotinib in patients with advanced ALK gene-positive or recurrent NSCLC. METHODS Three methods were used to screen patients with advanced or recurrent NSCLC harboring ALK gene fusion/translocation. The patients with ALK positive tested by flourescence in situ hybridization (FISH) was given orally crizotinib, 250 mg, bid. The objective response rate (ORR), progression-free survival (PFS) and safety were evaluated. RESULTS A total of 226 patients were screened, 39 of whom had ALK fusion or translocation, and 37 were enrolled in the study. 35 patients were evaluated for objective response, ORR was 70.3%, and disease control rate (DCR) was 94.6%, and median PFS was 11.8 mon. The main adverse reactions were elevated transaminase (Grade 1, 91.7%), elevated transaminases (Grade 2, 23.4%), nausea (Grade 1, 75.6%), anemia (Grade 1-2, 62.3%), visual impairment (Grade 1, 21.8%), weight loss (Grade 1, 31.4%), pneumonia (Grade 2, 3.5%). CONCLUSIONS Crizotinib can be used for the treatment of advanced NSCLC with ALK fusion/translocation. It is highly effective and well tolerated.
Collapse
Affiliation(s)
- Xiaoyan Li
- Department of Oncologic Comprehensive Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Huayan Xu
- Department of Lung Cancer, The Fifth Medical Center, General Hospital of People's Liberation Army, Beijing 100071, China
| | - Fang Gao
- Department of Lung Cancer, The Fifth Medical Center, General Hospital of People's Liberation Army, Beijing 100071, China
| | - Xun Kang
- Department of Oncologic Comprehensive Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Juan Zhang
- Department of Lung Cancer, The Fifth Medical Center, General Hospital of People's Liberation Army, Beijing 100071, China
| | - Jing Zhao
- Department of Lung Cancer, The Fifth Medical Center, General Hospital of People's Liberation Army, Beijing 100071, China
| | - Yi Lin
- Department of Oncologic Comprehensive Therapy, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Xiaoqing Liu
- Department of Lung Cancer, The Fifth Medical Center, General Hospital of People's Liberation Army, Beijing 100071, China
| |
Collapse
|
5
|
Suh CH, Kim KW, Pyo J, Hatabu H, Nishino M. The incidence of ALK inhibitor-related pneumonitis in advanced non-small-cell lung cancer patients: A systematic review and meta-analysis. Lung Cancer 2019; 132:79-86. [PMID: 31097098 DOI: 10.1016/j.lungcan.2019.04.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 03/14/2019] [Accepted: 04/08/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We evaluated the incidence of pneumonitis in clinical trials of anaplastic lymphoma kinase (ALK) inhibitors in patients with advanced non-small cell lung cancer (NSCLC) and compared the incidence among different cohorts, in order to identify possible predisposing factors for ALK inhibitor-related pneumonitis. METHODS MEDLINE and EMBASE search up to 1/30/18 using the keywords, "alectinib", "ceritinib", "crizotinib", "brigatinib", and "lung cancer", resulting in a total of 20 eligible cohorts with 2261 patients treated with ALK inhibitor monotherapy for advanced NSCLC. The pooled incidences of all-grade, high-grade, and grade 5 pneumonitis were calculated. Subgroup analyses were conducted with meta-regression using study-level covariates. RESULTS The overall pooled incidence of pneumonitis was 2.14% (95% CI: 1.37-3.34) for all grade, 1.33% (95% CI: 0.80-2.21) for high grade, and 0.22% (95% CI: 0.09-0.52) for grade 5 pneumonitis. The incidence was significantly higher in studies from Japan compared to studies of non-Japan origin, for all-grade (6.25% vs 1.14%, p < 0.001) and high-grade pneumonitis (3.31% vs 0.39%, p < 0.001). Multivariate meta-regression demonstrated the cohorts from Japanese studies had significantly higher odds of pneumonitis for all-grade (odds ratio [OR]: 4.329 [95% CI: 1.918, 9.770], p < 0.001) compared to those of non-Japan origin, after adjusting for types of ALK inhibitors. CONCLUSIONS The overall incidence of ALK inhibitor pneumonitis was 2.14% in patients with advanced NSCLS. The patients from Japanese cohorts had a higher incidence of ALK-inhibitor pneumonitis, which indicates the need for increased awareness and caution for pneumonitis in Japanese patients treated with ALK inhibitors.
Collapse
Affiliation(s)
- Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Republic of Korea
| | - Junhee Pyo
- WHO Collaborating Center for Pharmaceutical Policy and Regulation, Department of Pharmaceutical Science, Utrecht University, David de Wiedgebouw, Universiteitsweg 99 3584 CG, Utrecht, the Netherlands
| | - Hiroto Hatabu
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA, USA
| | - Mizuki Nishino
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA, USA.
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Naccache JM, Gibiot Q, Monnet I, Antoine M, Wislez M, Chouaid C, Cadranel J. Lung cancer and interstitial lung disease: a literature review. J Thorac Dis 2018; 10:3829-3844. [PMID: 30069384 DOI: 10.21037/jtd.2018.05.75] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The association between lung cancer (LC) and interstitial lung disease (ILD) can be explained by the shared risk factors like smoking and physiopathology of fibrogenesis and cancerogenesis. The relative LC risk is shown to be 3.5- to 7.3-times higher in ILD, with LC occurrence estimated at 10-20% in ILD, with >15% of ILD patients likely to die from LC. ILD incidence upon LC diagnosis varied from 2.4-10.9%. Primary radiological presentations consist of peripheral lesions, mostly in the inferior pulmonary lobes, either close to or within the ILD areas. There is a trend towards inverted proportion of adenocarcinomas and squamous-cell carcinomas, with EGFR mutations very rarely found. ILD negatively impacted LC prognosis, with surgery associated with increased morbidity-mortality, particularly due to acute exacerbation (AE) of ILD. Limited resection reduced this risk, whilst increasing that of cancer mortality. Studies on radiotherapy that can induce AE-ILD are scarce. Chemotherapy was associated with similar response rates to those in LC patients without ILD, yet worse survival. This difference may be accounted for by ILD patients' poorer health and higher risk of drug-induced pneumonitis. Further studies are warranted to better understand cancer physiopathology within the fibrotic areas, along with the therapeutic strategies required.
Collapse
Affiliation(s)
- Jean-Marc Naccache
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de Pneumologie, Paris, France
| | - Quentin Gibiot
- Centre Hospitalier Intercommunal de Creteil, Service de Pneumologie, Creteil, France.,INSERM UMR U955, Faculté de Médecine, Université Paris Est (UPEC), Créteil, France
| | - Isabelle Monnet
- Centre Hospitalier Intercommunal de Creteil, Service de Pneumologie, Creteil, France
| | - Martine Antoine
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service d'Anatomie et Cytologie pathologique, Paris, France
| | - Marie Wislez
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de Pneumologie, Paris, France.,Sorbonne Universités, UPMC University Paris VI, Theranoscan, Paris, France
| | - Christos Chouaid
- Centre Hospitalier Intercommunal de Creteil, Service de Pneumologie, Creteil, France.,INSERM UMR U955, Faculté de Médecine, Université Paris Est (UPEC), Créteil, France
| | - Jacques Cadranel
- Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Service de Pneumologie, Paris, France.,Sorbonne Universités, UPMC University Paris VI, Theranoscan, Paris, France
| |
Collapse
|
8
|
Yasuda Y, Nomizo T, Ozasa H, Funazo T, Tsuji T, Yoshida H, Sakamori Y, Nagai H, Handa T, Kubo T, Kim YH. Retrospective analysis of acute exacerbation of interstitial lung diseases with nanoparticle albumin-bound paclitaxel in patients with advanced lung cancer with preexisting interstitial lung disease. Mol Clin Oncol 2017; 7:677-680. [PMID: 29046799 DOI: 10.3892/mco.2017.1373] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Accepted: 07/12/2017] [Indexed: 11/06/2022] Open
Abstract
Lung cancer with preexisting interstitial lung disease (ILD) is difficult to treat due to the risk of acute exacerbation of ILD. Nanoparticle albumin-bound (nab-) paclitaxel improves the overall response rate and reduces neuropathy more efficiently compared with conventional solvent-based (sb-) paclitaxel in patients with advanced non-small-cell lung cancer. However, it is not known whether the risk of acute exacerbation of ILD with nab-paclitaxel is higher compared with that with sb-paclitaxel. Advanced lung cancer patients with ILD treated with nab-paclitaxel (n=14) or sb-paclitaxel (n=14) were retrospectively reviewed. Acute exacerbation of ILD developed in 1/14 patients (7.7%) receiving nab-paclitaxel and 3/14 patients (21.4%) receiving sb-paclitaxel; the difference was not statistically significant. To the best of our knowledge, this is the first study to compare the incidence of acute exacerbation of ILD with nab-paclitaxel with that of sb-paclitaxel in patients with advanced lung cancer with preexisting ILD. The results of the present study support conducting a prospective clinical trial to confirm the clinical benefit of this agent.
Collapse
Affiliation(s)
- Yuto Yasuda
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Takashi Nomizo
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Hiroaki Ozasa
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Tomoko Funazo
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Takahiro Tsuji
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Hironori Yoshida
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Yuichi Sakamori
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Hiroki Nagai
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Tomohiro Handa
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Takeshi Kubo
- Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Young Hak Kim
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| |
Collapse
|
9
|
Yoneda KY, Scranton JR, Cadogan MA, Tassell V, Nadanaciva S, Wilner KD, Stollenwerk NS. Interstitial Lung Disease Associated With Crizotinib in Patients With Advanced Non-Small Cell Lung Cancer: Independent Review of Four PROFILE Trials. Clin Lung Cancer 2017; 18:472-479. [PMID: 28373069 DOI: 10.1016/j.cllc.2017.03.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/23/2017] [Accepted: 03/06/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Interstitial lung disease (ILD) is a rare, but potentially serious, side effect associated with crizotinib, a tyrosine kinase inhibitor for anaplastic lymphoma kinase-positive (ALK+) advanced non-small cell lung cancer. Our objective was to determine the incidence and nature of ILD associated with crizotinib in 4 PROFILE trials (ClinicalTrials.gov identifiers, NCT00585195, NCT00932451, NCT00932893, and NCT01154140). MATERIALS AND METHODS Grade ≥ 3 respiratory adverse events (AEs) and serious AEs (SAEs) and any grade AEs/SAEs reported as pneumonitis, ILD, or radiation pneumonitis in trials PROFILE 1001, PROFILE 1005, PROFILE 1007, and PROFILE 1014 were evaluated by an expert independent review committee that included a pulmonologist, medical oncologist, and radiologist. Events were designated as disease progression, de novo ILD possibly or probably related to crizotinib, exacerbation or recurrence of pre-existing ILD, concurrent illness, other toxicity not thought to be related to ILD, or inconclusive. RESULTS The independent review committee evaluated 446 events (in 368 of 1669 patients who had received crizotinib therapy). They classified these events as follows: progressive disease, 77; de novo ILD, 20; pre-existing ILD, 3; concurrent illness, 9; other toxicities, 310; and inconclusive, 27. The incidence of de novo ILD was 1.2% overall, 1.3% in whites, and 1.2% overall in Asians, but greater at 3.7% in Japanese patients. The median onset of ILD from the initiation of crizotinib therapy was 23 days (range, 3-763 days). The mortality rate due to ILD was 50%. Survival was improved if crizotinib was discontinued on presentation of ILD (9 of 14 patients) compared with discontinued later or continued (1 of 6 patients). CONCLUSION ILD associated with crizotinib, although rare, can occur at any time and requires close monitoring.
Collapse
Affiliation(s)
- Ken Y Yoneda
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA.
| | | | | | | | | | | | - Nicholas S Stollenwerk
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of California, Davis, Sacramento, CA
| |
Collapse
|
10
|
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.
Collapse
|
11
|
Chino H, Sekine A, Kitamura H, Kato T, Ogura T. Successful treatment with alectinib after crizotinib-induced interstitial lung disease. Lung Cancer 2015; 90:610-3. [PMID: 26452431 DOI: 10.1016/j.lungcan.2015.09.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 08/28/2015] [Accepted: 09/18/2015] [Indexed: 12/13/2022]
Abstract
We herein report a case of a 46-year-old woman with anaplastic lymphoma kinase (ALK)-rearranged stage IV lung adenocarcinoma who received the ALK inhibitor crizotinib as second-line therapy. On the 47th day following crizotinib initiation, a chest computed tomography scan revealed ground-glass opacities with a clinical manifestation of desaturation, although a partial response to treatment was detected. The diagnosis of crizotinib-induced interstitial lung disease (ILD) was confirmed, and crizotinib was discontinued, followed by the initiation of corticosteroid therapy. After improvement of ILD with corticosteroid therapy, alectinib was administered as salvage therapy, resulting in tumor shrinkage without any recurrence of ILD. To the best of our knowledge, this is the first report of successful alectinib treatment following crizotinib-induced ILD. Our results indicate that alectinib could be a promising alternative treatment option in patients with crizotinib-induced ILD.
Collapse
Affiliation(s)
- Haruka Chino
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Akimasa Sekine
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Hideya Kitamura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| | - Terufumi Kato
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan.
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Japan
| |
Collapse
|
12
|
Yamamoto Y, Okamoto I, Otsubo K, Iwama E, Hamada N, Harada T, Takayama K, Nakanishi Y. Severe acute interstitial lung disease in a patient with anaplastic lymphoma kinase rearrangement–positive non–small cell lung cancer treated with alectinib. Invest New Drugs 2015; 33:1148-50. [DOI: 10.1007/s10637-015-0284-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 08/26/2015] [Indexed: 10/23/2022]
|
13
|
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.
Collapse
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 ;
| |
Collapse
|
14
|
Beyond the Vascular Endothelial Growth Factor Axis: Update on Role of Imaging in Nonantiangiogenic Molecular Targeted Therapies in Oncology. AJR Am J Roentgenol 2015; 204:919-32. [DOI: 10.2214/ajr.14.12876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
15
|
Girard N, Audigier-Valette C, Cortot AB, Mennecier B, Debieuvre D, Planchard D, Zalcman G, Moro-Sibilot D, Cadranel J, Barlési F. ALK-rearranged non-small cell lung cancers: how best to optimize the safety of crizotinib in clinical practice? Expert Rev Anticancer Ther 2014; 15:225-33. [PMID: 25413260 DOI: 10.1586/14737140.2014.986103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Crizotinib (XALKORI™, Pfizer) is a tyrosine kinase inhibitor targeting ALK, MET and ROS1, currently approved for the treatment of adults with ALK-rearranged non-small-cell lung cancer. Optimizing the management of frequent crizotinib-related adverse events is crucial to ensure its continuous administration and reproduce the response and survival rates reported in clinical trials. Here, we propose some practical measures, which are mostly derived from the recommendations given to the investigators of the PROFILE 1001, 1005, 1007 and 1014 trials and are based on experience and scientific findings regarding the management of these disorders. While visual disturbances or bradycardia are frequent but benign, the severity of the cardiac and hepatic adverse events requires special attention potential to QT interval prolongations and to the monitoring of electrolyte levels and liver function, taking into account potential drug-drug interactions.
Collapse
Affiliation(s)
- Nicolas Girard
- Department of Respiratory Medicine and Thoracic Oncology, Hôpital Louis Pradel, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Lyon, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Kanaji N, Tadokoro A, Watanabe N, Inoue T, Ishii T, Dobashi H, Bandoh S. Increases in serum CYFRA21-1 concentration during successful treatment with crizotinib. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:480-4. [PMID: 25380070 PMCID: PMC4228946 DOI: 10.12659/ajcr.891194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Case series Patient: — Final Diagnosis: — Symptoms: — Medication: — Clinical Procedure: — Specialty: —
Collapse
Affiliation(s)
- Nobuhiro Kanaji
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Akira Tadokoro
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Naoki Watanabe
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takuya Inoue
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Tomoya Ishii
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hiroaki Dobashi
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Shuji Bandoh
- Department of Internal Medicine, Division of Hematology, Rheumatology and Respiratory Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| |
Collapse
|
17
|
[ALK-rearranged non-small cell lung cancer: how to optimize treatment with crizotinib in routine practice?]. Bull Cancer 2014; 101:823-31. [PMID: 25299566 DOI: 10.1684/bdc.2014.1976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Crizotinib (XALKORI(™), Pfizer) is a tyrosine kinase inhibitor of ALK, MET, and ROS1, which is currently approved for the second line treatment for ALK-rearranged lung cancer. This work from an expert group, based on the review of the data from the Profile studies, aims to provide practical elements in order to optimize the tolerability of crizotinib. Specific major or frequent side effects of crizotinib are discussed: visual disturbances, cardiac effects, elevated transaminases, and hypogonadism. In the routine practice, patients should be advised about visual disturbances, especially with regard to driving in low brightness. Digestive disorders related to crizotinib are exceptionally persistent or severe. Dietary measures and symptomatic treatments usually control these disorders. It is recommended to perform an electrocardiogram before introduction of crizotinib, to identify prolonged QT interval. Torsades de pointes may produce dizziness or syncope. Hypogonadism should be considered in case of fatigue, decreased libido, and even depression, taking into account that these symptoms may be related to cancer; testosterone serum level should be measured to identify patients that may be eligible to receive a supplementation. Monitoring of liver function tests, including transaminases and bilirubin, is necessary. To conclude, these practical elements are helpful to optimize treatment with crizotinib in patients with ALK-rearranged lung cancer; in the future, academic initiatives should be taken to study these aspects, based on the monitoring of large cohorts of patients treated with crizotinib.
Collapse
|
18
|
The safety and efficacy of paclitaxel and carboplatin with or without bevacizumab for treating patients with advanced nonsquamous non-small cell lung cancer with interstitial lung disease. Cancer Chemother Pharmacol 2014; 74:1159-66. [DOI: 10.1007/s00280-014-2590-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 09/10/2014] [Indexed: 12/24/2022]
|
19
|
Vansteenkiste JF. Ceritinib for treatment of ALK-rearranged advanced non-small-cell lung cancer. Future Oncol 2014; 10:1925-39. [PMID: 24856155 DOI: 10.2217/fon.14.94] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The anaplastic lymphoma kinase (ALK) gene plays a key role in the pathogenesis of selected tumors, including non-small-cell lung cancer (NSCLC). Patients with ALK-rearranged NSCLC are initially sensitive to the ALK inhibitor crizotinib but eventually become resistant, limiting its therapeutic potential. Ceritinib is an oral second-generation ALK inhibitor with greater preclinical antitumor potency than crizotinib in ALK-positive NSCLC. A Phase I trial of ceritinib in ALK-positive tumors demonstrated good activity in patients with advanced NSCLC, including those who had progressed on crizotinib. Adverse events are similar to those seen with other ALK tyrosine kinase inhibitors and are generally manageable. Ongoing trials are evaluating ceritinib in patients with ALK-rearranged NSCLC treated with prior chemotherapy and/or crizotinib.
Collapse
Affiliation(s)
- Johan F Vansteenkiste
- University Hospital KU Leuven, Respiratory Oncology Unit (Pulmonology), Herestraat 49, Leuven B-3000, Belgium.
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|