Osteoblastic Reaction in Non-small Cell Lung Carcinoma and its Association to Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors Response and Prolonged Survival

Pluquet, E.; Cadranel, Jacques; Legendre, Anne; Faller, M; Souquet, Pierre Jean; Zalcman, Gérard; Pérol, Maurice; Fraboulet, G.; Oliveiro, G.; Fraipont, Florence de; Quoix, Élisabeth; Lantuéjoul, Sylvie; Milleron, B.; Moro-Sibilot, Denis

doi:10.1097/jto.0b013e3181cf0440

Cited by 56 publications

(27 citation statements)

References 19 publications

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“…Although the frequency of flare phenomenon in lung cancer is unknown, treatments involving the use of molecular target drugs seem to yield more reports of these phenomena compared to those involving standard cytocidal chemotherapies. Some studies about bone metastasis of breast cancer have associated flare phenomena with favorable prognoses (Colemaan et al 1988;Koizumi et al 1999), and the same has been suggested for lung cancer (Pluquet et al 2010).…”

Section: Discussionmentioning

confidence: 83%

Flare Phenomenon Following Gefitinib Treatment of Lung Adenocarcinoma with Bone Metastasis

Hashisako

Wakamatsu

Ikegame

et al. 2012

Tohoku J. Exp. Med.

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The skeleton is the most common site for distant metastasis in patients with cancer. To detect bone metastasis and evaluate the efficacy of treatment, we usually use bone scintigraphy and check serum alkaline phosphatase (ALP). However, such evaluation is sometimes difficult due to flare phenomenon. A 61-year-old male was referred to our department with a suspected diagnosis of lung cancer. Following thorough examinations, he was diagnosed with primary lung cancer (adenocarcinoma, Stage IV) and found to have a mutation in the epidermal growth factor receptor gene at exon 21 (L858R). After initiating treatment with oral gefitinib, ALP increased and peaked at 3,592 U/L by 3 weeks and decreased thereafter. At 4 weeks following treatment initiation, bone scintigraphy revealed a marked increase in abnormal accumulation of 99m Tc-polyphosphate, but the primary tumor and metastases in regions other than the bone were reduced. At 9 weeks after treatment initiation, abnormal accumulations was improved in bone scintigraphy, and computed tomography revealed osteoblastic changes consistent with the accumulated lesion observed by bone scintigraphy. After initiating cancer treatment for bone metastasis, it is not uncommon to observe transient asynchronous accumulation in bone scintigraphy or transient increases in ALP in patients who ultimately respond to the treatment. These changes are called flare phenomenon, and documented in patients with prostate cancer or breast cancer receiving treatment. When determining the efficacy of treatments that target carcinomas with bone metastases, it is important to note that flare phenomenon is often indistinguishable from disease progression indicators.

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Section: Discussionmentioning

confidence: 83%

Flare Phenomenon Following Gefitinib Treatment of Lung Adenocarcinoma with Bone Metastasis

Hashisako

Wakamatsu

Ikegame

et al. 2012

Tohoku J. Exp. Med.

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“…On the other hand, radiographic osteoblastic change of metastasis before treatment was also regarded as a favorable prognostic marker for NSCLC treated with EGFR-TKI. [10] It is suggested that osteoblastic reaction regardless before or after the initiation of treatment might influence tumor reduction, as well as ALP flare phenomenon.…”

Section: Discussionmentioning

confidence: 99%

Alkaline phosphatase flare with hyperostosis of bone metastases in lung adenocarcinoma treated with gefitinib

Kaneko¹,

Shimura²,

Matsumoto³

et al. 2017

JCMT

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Alkaline phosphatase (ALP) flare has been reported to occur during cancer treatment as a favorable event, particularly in the presence of bone metastasis. There have been only a few reports in lung cancer and associated radiographic findings have seldom been described. The authors observed ALP flare in a female patient with lung adenocarcinoma soon after the initiation of gefitinib. Moreover, on computed tomography, metastatic lesions of the rib and thoracic spine showed marked hyperostosis, with sizes larger than the original bone structure, suggesting efficacy of gefitinib. The significance of such hyperostosis should be elucidated. Key words:Alkaline phosphatase, bone metastasis, hyperostosis, gefitinib ABSTRACTArticle history:

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“…De même, en cas d'apparition d'une métastase unique, par exemple au niveau cérébral ou osseux, il est recommandé de proposer un traitement local (chirurgie ou radiothérapie) sur celle-ci et de poursuivre la thérapie ciblée [7]. L'apparition d'une lésion osseuse condensante ou la transformation de lésions lytiques en lésions condensantes sont actuellement considérées comme un marqueur d'efficacité de la thé-rapie ciblée et non de progression tumorale [8].…”

Section: L'identification D'anomalies Oncogéniques Activatrices (Egfrunclassified

Avancées médicamenteuses en oncologie thoracique

et al. 2017

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Osteoblastic Reaction in Non-small Cell Lung Carcinoma and its Association to Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors Response and Prolonged Survival

Cited by 56 publications

References 19 publications

Flare Phenomenon Following Gefitinib Treatment of Lung Adenocarcinoma with Bone Metastasis

Flare Phenomenon Following Gefitinib Treatment of Lung Adenocarcinoma with Bone Metastasis

Alkaline phosphatase flare with hyperostosis of bone metastases in lung adenocarcinoma treated with gefitinib

Avancées médicamenteuses en oncologie thoracique

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