crizotinib and Ulcer

Herein, the authors describe the case of a 31-year-old female patient with primary metastatic adenocarcinoma of the lung referred for radiation therapy of newly diagnosed intramedullary spinal cord metastasis at C4/5 and an adjacent osteolytic lesion. Radiotherapy of the cervical spine level C3 to C5, including the whole vertebra, was performed with 30 Gy in 10 fractions. The patient's systemic therapy with crizotinib 250 mg twice daily was continued. After 8 fractions of radiation the patient developed increasing dysphagia. Ulceration of the hypopharynx and the upper esophagus were obvious in esophagoscopy and CT. Hospitalization for analgesia and percutaneous endoscopic gastrostomy (PEG) was required. First oral intake was possible 3 weeks after the onset of symptoms. The early onset, severity, and duration of mucositis seemed highly unusual in this case. A review of the literature failed to identify any reference to increased mucositis after radiation therapy concurrent with crizotinib, although references to such an effect with other tyrosine kinase inhibitors (TKI) were found. Nevertheless, the authors presume that a considerable risk of unexpected interactions exists. When crizotinib and radiotherapy are combined, heightened attention toward intensified reactions seems to be warranted.

Topics: Adenocarcinoma; Adult; Cervical Vertebrae; Chemoradiotherapy; Crizotinib; Deglutition Disorders; Enteral Nutrition; Esophagoscopy; Esophagus; Female; Humans; Hypopharynx; Lung Neoplasms; Mucositis; Pyrazoles; Pyridines; Radiation Injuries; Radiotherapy Dosage; Spinal Cord Neoplasms; Spinal Neoplasms; Tomography, X-Ray Computed; Ulcer

Crizotinib was the first clinically available inhibitor of the tyrosine kinase ALK, and next-generation ALK inhibitors, such as alectinib, are now under development. Although crizotinib is generally well tolerated, severe esophageal injury has been reported as a rare but serious adverse event of crizotinib therapy. We now describe the successful treatment with alectinib of a patient who developed crizotinib-induced esophageal ulceration.

Topics: Carbazoles; Carcinoma, Non-Small-Cell Lung; Crizotinib; Endoscopes; Esophageal Diseases; Female; Humans; Lung Neoplasms; Middle Aged; Piperidines; Protein Kinase Inhibitors; Pyrazoles; Pyridines; Tomography, X-Ray Computed; Treatment Outcome; Ulcer

Topics: Aged; Antineoplastic Agents; Carcinoma, Non-Small-Cell Lung; Crizotinib; Esophageal Diseases; Esophagoscopy; Female; Humans; Protein Kinase Inhibitors; Pyrazoles; Pyridines; Ulcer

This report describes esophageal ulcer as a novel adverse event associated with crizotinib therapy. Although crizotinib is generally well tolerated, physicians should be aware of the possibility of this adverse event.

Topics: Adult; Antineoplastic Agents; Carcinoma, Non-Small-Cell Lung; Crizotinib; Endoscopy, Digestive System; Esophageal Diseases; Female; Humans; Lung Neoplasms; Protein Kinase Inhibitors; Pyrazoles; Pyridines; Ulcer