晚期ALK融合阳性非小细胞肺癌治疗全程管理1例

Whole-process Management of Treatment of Advanced ALK Positive Non-small Cell Lung Cancer:A Case Report

背景与目的间变性淋巴瘤激酶(anaplastic lymphoma kinase,ALK)是晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)的重要治疗靶点。近几年来,随着多个ALK酪氨酸酶抑制剂(tyrosine kinase inhibitor,TKI)的出现,ALK融合阳性患者的总生存期(overall survival,OS)也在逐渐延长。现报道1例晚期ALK融合阳性NSCLC患者5余年的治疗经过,分析其治疗过程及效果评价,为后续患者的治疗提供经验。方法回顾性分析内蒙古赤峰市医院肿瘤内科三病区2015年7月3日收治的1例晚期ALK融合突变阳性肺癌患者的诊疗过程。结果患者男性,42岁,因“间断咳嗽、胸闷2个月,确诊肺腺癌1天”于2015年7月3日入我科。影像学检查提示左肺下叶占位,合并纵隔淋巴结肿大及左侧包裹性胸腔积液。支气管镜病理提示非小细胞癌,考虑腺癌。诊断:左肺下叶腺癌T1bN2M1a IV期。荧光原位杂交技术(fluorescence in situ hybridization,FISH)提示ALK(2p23)染色体易位。给予多西他赛+顺铂方案化疗2个周期,病情进展,改为培美曲塞+卡铂方案联合化疗6个周期,后续应用培美曲塞单药维持4个周期,疗效评估:部分缓解(partial remission,PR)。2016年4月9日给予克唑替尼治疗,2019年8月发现颅内多发转移,给予全脑放疗。2019年9月4日始口服恩沙替尼治疗至今。截至2021年3月1日,患者随访良好。结论该晚期ALK融合阳性肺腺癌患者,一线及二线选用化疗,后线应用ALK-TKI治疗,总OS达68个月,目前随访良好。

Background and objective Anaplastic lymphoma kinase(ALK)is an important therapeutic target for advanced non-small cell lung cancer(NSCLC).In recent years,with the emergence of several ALK tyrosine kinase inhibitors(TKI),the overall survival(OS)of ALK fusion positive patients is gradually extended.This paper reports the treatment of a late stage non-small cell lung cancer(NSCLC)patient with ALK fusion positive for more than 5 years,and analyzes the treatment process and effect evaluation,so as to provide experience for the follow-up treatment of patients.Methods The diagnosis and treatment process of a patient with advanced ALK fusion mutation positive lung cancer admitted to the third ward of Department of oncology,Chifeng hospital,Inner Mongolia on July 3,2015 was retrospectively analyzed.Results A 42 years old male patient was admitted to our department on July 3,2015 for"intermittent cough,chest tightness for 2 months,diagnosed with lung adenocarcinoma for 1 day".Imaging examination showed a space occupying lesion in the left lower lobe of the lung,accompanied by mediastinal lymphadenopathy and left encapsulated pleural effusion.Bronchoscopic pathology showed non-small cell carcinoma,and adenocarcinoma was tentatively suggested.Diagnosis:left lower lobe adenocarcinoma T1bN2M1a stage IV.Fluorescence in situ hybridization(FISH)indicated the translocation of ALK(2p23)chromosome.After 2 cycles of docetaxel+cisplatin(DP)regimens chemotherapy,disease progression occurred,so we used 6 cycles of pemetrexed+carboplatin to apply combination chemotherapy,4 cycles of pemetrexed monotherapy were used after that.The efficacy evaluation:PR.On April 9,2016,the patient was treated with crizotinib.In August 2019,multiple intracranial metastases were found and whole brain radiotherapy was given.Since September 4,2019,oral administration of nsatinib has been carried out.As of March 1,2021,the patients were followed up well.Conclusion The advanced ALK fusion positive lung adenocarcinoma patients,though the first-line and the second-line chemotherapy,and the follwing application of ALK-TKI treatment,has procured a total OS has reached 68 months,and the current follow-up is good.