crizotinib and Bone-Marrow-Neoplasms

Distant metastasis was common in lung cancer, especially patients with bone marrow metastasis had poor prognosis and there were few effective methods. Crizotinib had been confirmed to be used in anaplastic lymphoma kinase (ALK) positive lung adenocarcinoma, but the efficacy in lung cancer with bone marrow metastasis was unknown. In the present study, we reported one case of ALK-positive lung adenocarcinoma with bone marrow matastasis given crizotinib treatment, the safety and efficacy was summarized.. ALK fusion was tested by fluorescence in situ hybridization (FISH). Crizotinib was given with dose of 250 mg, bid. Objective response was evaluated by Response Evaluation Criteriation in Solid Tumours (RECIST) v1.1 and bone marrow response was evaluated by bone marrow puncture and biopsy. Adeverse events were evaluated according to Common Terminology Criteria for Adverse Events (CTC AE) v4.0.. The patient achieved partial response (PR) after 6 weeks of crizotinib, especially the objective response of bone marrow metastasis was complete response (CR). The patient stopped crizotinib because of pneumonia. The progression free survival (PFS) and overall survival (OS) was 20 weeks and 22 weeks respectively.. Crizotinib could be an effective method for ALKpositive lung cancer with bone marrow metastasis and showed good tolerance.. 背景与目的 肺癌患者常伴远处转移，其中伴骨髓转移患者治疗手段有限，预后差。Crizotinib已被证实可用于治疗间变淋巴瘤激酶（anaplastic lymphoma kinase, ALK）阳性的肺腺癌，但对于骨髓转移癌的疗效如何罕见报道。本文总结1例crizotinib治疗ALK阳性肺腺癌伴骨髓转移患者，并对其有效性及安全性进行讨论和分析。方法 采用原位免疫荧光杂交法（fluorescence in situ hybridization, FISH）检测ALK融合基因阳性，一线化疗失败后给予crizotinib治疗，250 mg，2次/d。按照实体瘤疗效评价标准1.1版（Response Evaluation Criteriation in Solid Tumours, RECIST v1.1）评价客观疗效，采用骨髓活检评价骨髓转移瘤疗效。按照不良反应通用术语标准4.0版（Common Terminology Criteria for Adverse Events v4.0, CTC AE v4.0）评估用药期间发生的不良事件。结果 该患者服用crizotinib 6周后，总体疗效评价为部分缓解（partial response, PR），骨髓疗效为完全缓解（complete response, CR）。因出现肺炎停药，无进展生存期（progression-free survival, PFS）20周，总生存期（overall survival, OS）22周。结论 Crizotinib治疗ALK阳性的肺癌伴骨髓转移患者可达骨髓完全缓解，耐受性好。

Topics: Adenocarcinoma; Adenocarcinoma of Lung; Adult; Anaplastic Lymphoma Kinase; Bone Marrow Neoplasms; Crizotinib; Female; Gene Fusion; Humans; Lung Neoplasms; Pyrazoles; Pyridines; Receptor Protein-Tyrosine Kinases; Treatment Outcome