Rapid response in a critical lung adenocarcinoma presenting as large airway stenoses after receiving stent implantation and sequential rebiopsy guided ALK inhibitor therapy: a case report

Abstract

Airway stent implantation can improve the symptoms of airway stenosis caused by a malignant tumor immediately. However, stent implantation is only a palliative therapy and disease will quickly progress without subsequent treatment. Targeted therapy can provide accurate etiological treatment for patients with critical lung cancer who cannot receive chemotherapies. In our clinic, we encountered a 50-year-old male presenting with stage IV lung adenocarcinoma. He failed both the first-line and second-line chemotherapies and suffered severe complex left and right main bronchial stenoses caused by tumor invasion. An emergency stent was implanted to relieve dyspnea symptoms. At nearly the same time, he was detected to have an ALK gene fusion mutation upon rebiopsy and subsequently began crizotinib therapy. A short time later his obstructed airway returned to normal and lesions in the lung were miraculously reduced. This case indicates that the combination of stent implantation and real-time rebiopsy guided targeted therapy brings a new hope for patients with critical lung cancer. J Thorac Dis 2017;9(3):E230-E235 jtd.amegroups.com in another hospital. His biopsy specimen was acquired by TBNA and ALK status was detected by means of Ventana immunohistochemistry (IHC). He had received five cycles of combination chemotherapies containing carboplatin and pemetrexed and three cycles of combination chemotherapies containing gemcitabine and nedaplatin in that hospital. On arrival (D0), he was in respiratory distress with a respiratory rate of 28 bpm and oxygen saturation of 88-89% without oxygen inhalation. Physical examination was remarkable for scattered rhonchi and decreased breath sounds over both the lung fields. His performance status (PS) was grade 4 (Zubrod-ECOG-WHO score). A chest CT scan at the local hospital showed that the primary lesion had become lager, exacerbating both left and right main bronchial stenoses.Six days later, on D6, he underwent interventional therapy through flexible bronchoscope (FB) (Figure 1). We observed a large new lesion in the carina which was a typical aspect of the invasion of the two main stems bronchi from the mediastinum by the invasion of International Association for the Study of Lung Cancer (IASLC) lymph node station 7. The right main bronchus was completely occluded. We used argon plasma coagulation (APC) to treat the bleeding in the right main bronchus and rebiopsied the neoplasm in the left main bronchus. The neoplasm was then taken for pathologic examination and mutational analyses were completed for EGFR, ALK and ROS1 genes. On D10, under local anaesthesia, he was examined by FB again. We could see the left main bronchial stenosis was slightly relieved while right main bronchus was still obstructed by tumor tissue. We inserted a stent in the left main bronchus through the work way of FB and under its direct vision. When the airway stent was released, we adjusted its position with biopsy forceps and then dilated the airway with a balloon catheter. At last, the stent op...

Airway stenosis secondary to mediastinal lymph node metastasis of lung adenocarcinoma treated with AERO stent and osimertinib: A case report

“…These stents can also be safely removed from patients who require stent removal, similar to silicone stents 1,2 . Few similar reports exist on combination therapy with molecular‐targeted agents and an airway stents 4–7 . It has been reported that airway stenosis in an ALK‐positive lung cancer case with severe airway stenosis improved after ALK‐TKI treatment and temporary placement of a silicone Y‐stent, which was removed 5–6 months later 5,6 .…”

“… 1 , 2 Few similar reports exist on combination therapy with molecular‐targeted agents and an airway stents. 4 , 5 , 6 , 7 It has been reported that airway stenosis in an ALK‐positive lung cancer case with severe airway stenosis improved after ALK‐TKI treatment and temporary placement of a silicone Y‐stent, which was removed 5–6 months later. 5 , 6 Furthermore, there have been reports on AERO stent removal due to the effects of immune checkpoint inhibitors.…”

Exceptional responses to PARP inhibitors in patients with metastatic breast cancer in oncologic crisis

“…However, targeting oncogenic drivers of disease may possibly result in rapid and profound treatment responses that can potentially reverse oncologic burden and improve patient outcomes. For example, the literature demonstrates that targeting ALK , EGFR , and BRAF gene mutations have resulted in remarkable responses in critical patients [ 11 – 14 ].…”