Case report: Indolent drug-related pneumonitis with alectinib therapy in the treatment of non-small cell lung cancer

Abstract

Molecular targeting therapy is becoming the standard of care for some patients with anaplastic lymphoma kinase (ALK)-rearranged lung adenocarcinoma. Drug-related pneumonitis (DRP) has been identified as an infrequent but potentially severe adverse effect. Herein, we report a 50-year-old woman with ALK-rearranged advanced lung adenocarcinoma who developed interstitial lung disease associated with alectinib therapy. At 102-day of treatment, chest CT revealed scattered ground glass opacities (GGOs) involving both lungs. Since she was asymptomatic and alectinib provided a beneficial tumor treatment response, alectinib therapy was continued. However, 2 months later, she presented with progressive dyspnea and diffuse GGOs on chest computed tomography. There was no evidence for infection or other etiologies for her lung complication. Alectinib was discontinued and steroid therapy was initiated which was followed by improvement in respiratory symptoms and chest CT findings; DRP was diagnosed. Although rare, alectinib therapy can cause DRP of indolent onset.

A non-small cell lung carcinoma patient responded to crizotinib therapy after alectinib-induced interstitial lung disease

“…一般来说，一旦怀疑药物相关ILD，应立即停用可能引起该病的药物，并给予积极的皮质类固醇治疗和对症支持治疗 ［ 6 ］ 。在临床实践中，医生们通常不愿意使用与导致ILD相关药物的类似药物。对于接受 ALK -TKI治疗后发生ILD的患者尚无标准的后续治疗方案。目前已有一些研究报道了发生 ALK -TKI相关ILD后的NSCLC患者成功使用 ALK -TKI进行再治疗的案例 ［ 7 - 11 ］ 。如有文献报道发生阿来替尼相关ILD后成功使用劳拉替尼或克唑替尼进行治疗的案例 ［ 12 - 14 ］ ；还有一些案例报道了发生克唑替尼、色瑞替尼或布加替尼相关ILD后，重新使用相同 ALK -TKI ［ 15 - 22 ］ 或其他 ALK -TKI ［ 23 - 28 ］ 均无ILD的复发。然而，值得注意的是，有一例使用阿来替尼后出现ILD的NSCLC患者继续使用阿来替尼后ILD进展 ［ 29 ］ ；另有4例发生克唑替尼相关ILD的患者在重新使用克唑替尼后出现了ILD复发 ［ 19 - 20 ］ 。…”