1例ALK融合阳性非小细胞肺癌患者6年治疗报告

Crizotinib in treatment of ALK positive non-small cell lung cancer: A case report

目的报告1例克唑替尼治疗ALK融合阳性非小细胞肺癌患者6年的治疗经过。方法患者女性,35岁,2012年12月因"体检发现右肺占位"就诊于我院。2012年12月31日行右锁骨上淋巴结切除活检,病理示低分化腺癌,诊断为右肺腺癌(T4N3M0ⅢB期)。该患者经FISH检测ALK融合阳性,于2013年2月7日开始口服克唑替尼250 mg,每日2次。分别于2014年11月4日和2016年2月24日出现颅脑转移,给予相应靶病灶射波刀放疗,同时继续口服克唑替尼。后因病灶控制不佳,2016年10月-2018年1月间断给予贝伐珠单抗400 mg静滴,同时联合口服克唑替尼。对该患者进行疗效及相关不良反应的随访,克唑替尼耐药后于2018年5月18日更换为艾乐替尼治疗,随访截至2018年9月30日,无严重不良反应发生。结果患者口服克唑替尼及联合局部治疗,共维持63.4个月,最佳疗效PR。结论 ALK阳性晚期非小细胞肺癌患者,一线使用克唑替尼治疗有效率高,治疗期间病情进展后,克唑替尼联合局部治疗,再次用药后疗效依然好。

Objective To report the experience of crizotinib treatment for anaplastic lymphoma kinase(ALK) positive non-small cell lung cancer(NSCLC) in 6 years. Methods The patient was a 35-year-old female, who was admitted to our center in December 2012 due to "right lung nodule detected by CT screening". On December 31, 2012, right supraclavicular lymph node resection biopsy was performed, and the pathology result showed low-differentiated adenocarcinoma. Then the patient was diagnosed as right lung adenocarcinoma(T4N3M0, stage Ⅲ B). FISH analysis identified ALK fusion in this patient, and then crizotinib was administered orally on February 7, 2013(250 mg twice per day). Craniocerebral metastases occurred on November 4, 2014 and February 24, 2016, respectively, and the corresponding target lesions were treated with cyberknife radiotherapy, while oral administration of crizotinib continued. Later, due to poor control of lesions, bevacizumab(400 mg) was given intermittently from October 2016 to January 2018, and crizotinib was taken orally at the same time. The patient was followed up for efficacy and related adverse reactions. After drug resistance, alectinib replaced crizotinib on May 18, 2018. By the end of September 30, 2018, no serious adverse reactions occurred. Results Oral administration of crizotinib combined local treatment was performed for 63.4 months, with the best response of PR. Conclusion For patients with ALK positive advanced non-small cell lung cancer, the first-line use of crizotinib is highly effective. After disease progression during the treatment, crizotinib combined with local treatment is still effective after reapplication.