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Case Reports
. 2016 Mar;10(3):XD01-XD03.
doi: 10.7860/JCDR/2016/17805.7428. Epub 2016 Mar 1.

Fatal Haemoptysis Associated with Dramatic Response to Crizotinib in an ALK-Rearranged Lung Adenocarcinoma

Elodie Mussat  1 , Violaine Giraud  1 , Catherine Julie  2 , Thierry Chinet  3 , Etienne Giroux Leprieur  3
Affiliations
Case Reports

Fatal Haemoptysis Associated with Dramatic Response to Crizotinib in an ALK-Rearranged Lung Adenocarcinoma

Elodie Mussat et al. J Clin Diagn Res. 2016 Mar.

Abstract

The presence of an ALK (Anaplastic Lymphoma Kinase) rearrangement is a rare molecular feature in Non-Small Cell Lung Carcinoma (NSCLC), and concerns mainly non- or light smokers, young patients, with adenocarcinoma histological type. These tumours are particularly sensitive to Alk-targeted therapies, as crizotinib. Crizotinib is usually well-tolerated. We report a case of fatal haemoptysis associated with dramatic response to crizotinib in a patient with an ALK-rearranged lung adenocarcinoma. The patient presented a mediastinal invasion with tracheal involvement and compression of the right pulmonary artery. The initial evolution under crizotinib was good with tumour response. At 6 weeks of crizotinib the patient presented a massive haemoptysis with a tracheobronchial fistula and pneumomediastinum. She died of acute respiratory failure. Our case is the first to report a fatal effect of crizotinib associated with tumour necrosis and good tumour response on a massive mediastinal infiltration. Precautions are recommended with the use of crizotinib in proximal lung tumours with vascular invasion.

Keywords: ALK rearrangement; Non-Small Cell Lung Carcinoma; Pneumomediastinum.

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Figures

[Table/Fig-1]:
[Table/Fig-1]:
a) CT at baseline shows massive mediastinal tumour infiltration with tracheal invasion; and b) infiltration of the right pulmonary artery.
[Table/Fig-2]:
[Table/Fig-2]:
Endobronchial aspect at baseline, showing a tracheal obstruction by the tumour.
[Table/Fig-3]:
[Table/Fig-3]:
Results of the bronchial biopsies. A, Haematein-Eosine-Safran (HES) coloration. B, thyroid transcription factor 1 (TTF1) positive staining. Magnification x13.
[Table/Fig-4]:
[Table/Fig-4]:
ALK immunohistochemistry results, showing strong positive staining in tumour cells. Magnification x13
[Table/Fig-5]:
[Table/Fig-5]:
Endobronchial aspect at 6 weeks, showing functional prosthesis without any migration or bronchial erosion.
[Table/Fig-6a&b]:
[Table/Fig-6a&b]:
CT after 6 weeks of crizotinib with good tumour response.
[Table/Fig-7a&b]:
[Table/Fig-7a&b]:
CT after 6 weeks of crizotinib. Presence of air in the mediastinum compatible with a pneumomediastinum
See this image and copyright information in PMC

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